Dr. Anirban Biswas

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.

How to treat hot flashes after menopause?
A hot flash, at times called a hot flush, is a speedy sensation of heat and once in a while a red, flushed face accompanied by sweating. The exact reason for hot flashes is not known, but rather might be associated with changes in circulation. Hot flashes happen when the blood vessels close to the skin's surface widen to cool. A woman may likewise sweat to chill off her body. What is more, a few ladies have a fast heart rate or chills. Hot flashes are the most common symptom of menopause.

Hot flashes differ among women experiencing menopause. A few of them have hot flashes for a brief span during menopause. Other ladies may have hot flashes forever. For the most part, hot flashes are less extreme over time. You most likely cannot maintain a strategic distance from hot flashes during menopause, yet there are things that might make them more serious. To prevent hot flashes, keep away from these triggers:

1. Stress
2. Caffeine
3. Liquor
4. Spicy nourishments
5. Tight clothing
6. Heat
7. Tobacco or smoke

Different things you can do to keep hot flashes under control include:

1. Stay cool: Keep your room cool during the evening. Use fans during the day. Wear light layers of garments with regular strands, for example, cotton. Using cooling pads to lay your head on during the evening may be useful.
2. Breathing: Try deep and moderate stomach breathing (six to eight breaths for each moment). Try to relax for fifteen minutes in the morning, fifteen minutes at night and at the onset of hot flashes.
3. Exercise: Exercise every day. Walking, swimming, moving, and bicycling are all great ways to keep fit and keep hot flashes at bay.
4. Hormone substitution treatment: Talk to your specialist about taking hormone substitution treatment, or HRT, for a brief span – less than 5 years. This treatment prevents hot flashes from occurring in numerous women. In addition, it can help different symptoms of menopause, including vaginal dryness and mood issue. Remember that when you quit taking HRT, the hot flashes may return. Short-term HRT has a few dangers, including blood clots and gallbladder aggravation. In case that HRT is not a good fit for you, there are different medicines that may offer help.
5. Botanicals and herbs: Some herbs can help soothe the hot flashes. These are:
   • Soy items: Plant estrogens, found in soy items, are thought to have weak estrogen-like impacts that may decrease hot flashes. Soy food and not supplements are prescribed.
   • Dark cohosh: A few studies propose that dark cohosh might be useful in the short-term (six months or less) to treat hot flashes and night sweats. Symptoms include gastrointestinal problems.
   • Evening primrose: This oil is another plant that is regularly used to treat hot flashes. Symptoms include queasiness and loose bowels. Ladies taking certain medicines, for example, blood thinners, should not take evening primrose oil.
   • Flaxseed: This is thought to diminish the side effects of menopause, especially hot flashes. It's otherwise called linseed. If you wish to discuss about any specific problem, you can consult an Endocrinologist.

If you are experiencing pain in the muscles and joints, an enhanced craving for salt, symptoms of low glucose in the blood or low blood pressure, you could be suffering from adrenal insufficiency (AI). The outer layer or cortex of our adrenal gland produces three forms of steroid hormones. In adrenal insufficiency, the cortex fails to produce enough steroid hormones. Some people do not know that they have been affected with adrenal insufficiency until they experience a sudden worsening of symptoms. This is called an adrenal crisis.

Causes
The different types of adrenal insufficiencies occur because of different reasons. Primary AI is commonly caused by autoimmune diseases in which our body’s defence system destroys the body’s tissues. Bleeding in glands, genetic diseases and infections are other likely causes.

Secondary AI occurs because of problems with the pituitary gland. The pituitary gland produces a hormone named adrenocorticotrophic hormone (ACTH) because of which the adrenal glands produce cortisol. In the case of secondary AI, the pituitary glands stop sending ACTH to the adrenal glands, and cortisol is hence not produced. This may occur by taking certain prescribed medicines.

Diagnosis
A patients’s medical symptoms and medical history are observed. The blood levels of cortisol, sodium, potassium and glucose are checked for the detection of AI. The adrenal glands and the pituitary gland are observed by imaging tests. X-rays, ultrasound, and CT and MRI scans may be required.

Treatment
The treatment of adrenal insufficiency aims at ensuring proper levels of hormones in the body. You may require regular replacement of hormones for life. You have to take glucocorticoids for replacing the cortisol which your body does not provide anymore. Mineralocorticoids should be taken when the body does not produce aldosterone. Extra glucocorticoids may be required during times of intense stress such as a surgery or serious health conditions.

1. Glucocorticoid helps the body in coping with stress, injury and illness. It helps in the regulation of blood glucose levels and blood pressure levels. It performs the function of cortisol.
2. Mineralocorticoid helps in maintaining a proper balance of water and salt in our body. This is actually carried out by aldosterone.
3. Adrenal androgens, which are weak male sex hormones, present in both men and women, help in the regulation of pubic and armpit hair growth in women.

If you experience any symptoms of adrenal insufficiency, it is recommended that you visit a doctor immediately. Early diagnosis will enable early treatment, which is beneficial for you. If you wish to discuss about any specific problem, you can consult an Endocrinologist.

Vitamin d deficiency is caused when your body does not get enough exposure to the sun that is the primary source of vitamin d for your body. It is crucial for the health of your bones, skin and neurological system, therefore, its deficiency may lead to a number of problems and risks such as rickets, osteoporosis, multiple sclerosis etc.

Here is a list of four symptoms that can help you to identify if you suffer from a deficiency of vitamin d.

1. Bone pain and muscle weakness

Adults who suffer from a deficiency of vitamin d feel a lot of achiness and pain in the bones and muscles of their body. Also, they are troubled with joint stiffness and fatigue that lowers the overall quality of their life.

2. Fits of sadness and grief

Exposure to the sun (and hence, vitamin d) improves the level of the neurotransmitter serotonin in your body that is responsible for lifting your spirits. However, deficiency of vitamin d prevents you from having a more positive outlook towards life. So, another symptom that can help you identify that your body is deficient in vitamin d is that you've got a lot of blues.

3. A lot of head sweat

If your head sweats a lot, you can be assured that you suffer from an acute deficiency of vitamin d. Head sweating is another prominent symptom associated with vitamin d deficiency. If you wish to discuss any specific problem, you can consult an endocrinologist.

The inflammation of your pancreas over a short period of time indicates acute pancreatitis, which is a serious health condition. You may experience symptoms such as severe abdomen pain all of a sudden, diarrhoea and feeling of being sick. Acute pancreatitis occurs when there are some problems with certain enzymes in the pancreas. This condition is often associated with gallstones and alcohol consumption.

Treatment
Acute pancreatitis can be cured in a hospital, where you will get monitored for signs of serious issues. In some cases, supportive things like oxygen and fluids are required. Here are the various ways by which the condition can be treated:

1. Fluids: The body may get dehydrated during acute pancreatitis. Fluids are provided via a tube connected to one of the veins of the patient. This is known as intravenous or IV fluid. These fluids may help in the prevention of a problem called hypovolemic shock, which occurs when the amount of blood in your body gets lowered due to a drop in fluids. 
2. Nutrition: Diet is usually not restricted for people with acute pancreatitis, but some patients are recommended not to consume solid food for some time. Attempting to digest solid food may cause a strain on the pancreas. You may need to avoid solid food for some days. You should use a feeding tube to get essential nutrients. This process is called enteral feeding and it may involve the insertion of a tube into your stomach via the nose. 
3. Oxygen: For ensuring sufficient oxygen supply to your vital organs, you will be supplied with oxygen through the tubes on your nose. The tube may be removed when your condition improves. In some cases, ventilation equipment may be required for assistance to breathe.
4. Painkillers: Acute pancreatitis causes severe abdominal pain and strong painkillers such as morphine may be given to the patient. These may make the patient feel drowsy. 

Treatment of underlying cause
After controlling the symptoms, the underlying cause must be treated. They are as follows:
1. Gallstone: When pancreatitis occurs because of a gallstone, you may require a process known as endoscopic retrograde cholangiopancreatography or ERCP. The gallbladder may have to be removed, if necessary. 

2. Alcohol consumption: After getting treated for acute pancreatitis and you have recovered from this condition, you should try to avoid alcohol completely. Alcohol may spoil your recovery and the condition might reoccur or the symptoms may reappear. For freedom from alcohol, you may try counselling, joining self-help groups such as Alcoholics Anonymous (AA) or take a medicine which reduces your craving for alcohol. 

It is recommended that you visit a doctor immediately after experiencing any slight or severe symptoms of acute pancreatitis. This will help in early diagnosis and the chances of the symptoms getting worse are prevented. If you wish to discuss about any specific problem, you can consult an Endocrinologist.

Adrenal gland cancer is a form of cancer which usually affects adrenals (tiny glands which sit above each kidney). The kidneys are situated inside the upper abdomen. The tumor usually develops in the outer part of the adrenal gland called the cortex. These hormones are called steroids and produce cortisol (hormone made in the adrenal gland) and sex hormones. 

Types of Adrenal Tumors:

1. Cancer in the outer part of the adrenal gland like adrenocortical carcinoma.
2. Neuroblastoma (usually affects children).
3. An extremely rare form of tumor called pheochromocytoma.

Symptoms of Adrenal Gland Cancer:

1. Low levels of potassium
2. High blood pressure
3. Panic attacks and anxiety can also occur
4. Nervousness
5. Throbbing sensation in the heart
6. Immense headache
7. Excessive amount of sweating
8. Pain in the abdominal area
9. Extreme fluctuation in blood sugar levels (diabetes)
10. Weight loss or weight gain for no reason.
11. Weakness and feelings of fatigue
12. Hair loss
13. Some changes in the genitalia.
14. Unusual occurrence of acne.
15. Changes in sex drive (libido).

Treatments of Adrenal Gland Cancer:

1. Surgery: This option can be considered in extreme cases. Surgery usually involves surgically removing the tumors. If the tumor is smaller than 5 cm, it might not be cancerous or dangerous. In this case a laparoscopic surgery is suggested.
2. Hormone Therapy: Adrenal glands might produce excess hormones during other treatments for curing adrenal gland cancer. The doctor might suggest drugs like metyrapone, streptozotocin, metyrosine and spironolactone to maintain your hormone levels.
3. Chemotherapy: This is the most common form of treatment to kill the cancer cells. Chemotherapy stops the cells ability to divide and grow thus destroying the cancer cells. During chemotherapy a patient is given a combination of different drugs at a time. The amount of adrenocorticoids which is produced by the adrenal glands during adrenal cancer is greatly reduced. The side effects of chemotherapy include nausea, vomiting, risk of infection, loss of appetite, hair loss, diarrhea and fatigue. If you wish to discuss any specific problem, you can consult an endocrinologist.

Here are some facts & Myths about Diabetes

Hello. Good Afternoon. I am Dr. Anirban Biswas. I am a diabetologist. I am practicing at Fortis Hospital. I want to discuss with you a few facts about Diabetes.

As you all know friends that diabetes is a leading cause of mobility in India. There are, basically, two types of diabetes; one is Type 1 Diabetes which is insulin dependent and usually occurs in small kids and children. The other one is Type 2 Diabetes which is mainly in adults and can be treated without the need of insulin. Now, first of all, we should focus what are the symptoms of diabetes. The symptoms of diabetes are weakness, lethargic, and you are not able to do your daily activity and second is that you are feeling irritable and disturbance in sleep, excessive thirst and hunger and frequent visits to the loo as you are not doing it earlier. You are having frequent breakages in you are sleep and you have to go to the toilet even at night time.

You may have non-healing ulcer, or skin infections which are not healing, you can also have other disturbances like visual disturbances and urinary infection or chest infection which is taking enough time to heal. All these symptoms can lead to diagnosis of diabetes and sudden loss of weight is also seen in few adults. So if you have diabetes, the best test to do is fasting and PP Sugar. Fasting sugar could be less than 110 and the PP sugar which is done after two hours of having your breakfast should be less than 140. If one of them is high then it is known as pre-diabetes then it is followed by a HbA1c test. HbA1c test is a glycosylated hemoglobin which tells us about the average blood sugar which is present in our body in the last three months. It should be less than 6 in case of a normal individual.

If it is more than that then you are either a pre-diabetic or diabetic. so, now coming to the treatment and modification part; the first thing that doctors advise is that insulin resistance is there so to break the insulin we have lose weight and for that we have to do regular exercise and control in our diet. The diet should be such that it should include all the course grain, milk, fruits, vegetables, sprouts and less of carbs, maida, processed food, fatty, oily should be avoided. The other focus should be on exercises as we all know that a 30 minute exercise and even 10000 steps everyday can reduce our insulin resistant drastically. If we can do all these things and it reduces our sugar then it is very well otherwise we have to take medicines and for that you have to visit any doctor.

The complications of diabetes basically it is known as diabetic triopathy. Diabetes is basically a vascular disease and has microvascular defects which causes disease in the retina, small vessels of the heart and brain and kidneys are involved and because this the patients weasel equity can go low and that is known as diabetic retinopathy. It is usually diagnosed by frequent eye checkups and the second disease which is known as chronic renal failure, for this also you have to go for the KFT test or even a better test is there which is known as microalbumin creatinine ratio and the third is diabetic neuropathy which is which causes pain and tinian sensation in the nerves. For this we have to take some medicines and vitamin B12 supplements along with diabetic supplements.

Thank you. If you have any query or you need to consut me then you can contact me through Lybrate. Thanks a lot.
 

Testosterone is often the subject of jokes but an insufficiency of this hormone is no laughing matter. Along with affecting your sex drive, low levels of testosterone can also affect your ability to concentrate on tasks, lead to high blood pressure and cholesterol. Additionally, it can increase your risk of obesity and type 2 diabetes. Here are a few signs that could indicate low levels of testosterone-

1. Decreased Libido: With age, you may experience a lowered libido but a sudden decline in your sex drive could be caused by a lack of testosterone.

2. Erectile Dysfunction: Lowered levels of testosterone in the body can affect the release of nitric oxide necessary for an erection. Men suffering from lowered testosterone levels often find themselves either not able to have an erection or have erections that are not firm enough for intercourse.

3. Fatigue: Feeling tired at the end of a day is normal but men who have lowered testosterone levels may find themselves feeling extremely tired by lunchtime. You may also notice a loss of drive and enthusiasm.

4. Moodiness: Men with low levels of testosterone often become depressed and dejected. They feel less optimistic than normal and become more irritable.

5. Reduced Muscles: Testosterone is linked to muscle building and hence a lowered level of testosterone can be indicated by a reduction in the arm, chest or leg muscles. Men with low testosterone also find it difficult to build muscle mass.

6. Lowered Attention Span: Testosterone is responsible for focus and attention. Hence, trouble concentrating on work and memory problems can be seen as signs of lowered testosterone levels.

7. Development of Breasts: The lack of testosterone can cause an imbalance of oestrogen to testosterone ratio in the body. As the oestrogen levels get higher, men may find themselves growing breast tissue. This condition is also known as gynecomastia.

8. Bone Problems: A lack of testosterone can affect bone density. This may lead to osteoporosis like conditions and joint pains. Men with low testosterone levels are also more prone to injuries.

9. Lowered Semen Production: Testosterone is directly linked to semen production. The lower a man’s testosterone levels, the lesser the amount of semen produced.

10. Hair Loss: Many men experiencing lowered testosterone levels suffer from hair loss on their head and other parts of the body as well.

The good news is that this disorder can be treated. Hence, if you find yourself experiencing any of these symptoms, consult a doctor at the earliest.

The food we eat contains energy which is stored as glucose in the body. This glucose is then converted into back into energy with the help of a hormone called insulin. A lack of insulin in the body or an inability to use the insulin is known as diabetes. There are two types of diabetes mellitus; type 1 and type 2. These diseases cannot be cured but with medication, correct nutrition and weight management, they can be controlled so as to not affect your quality of life.

Type 1 diabetes is a lifelong condition and usually, begins in childhood. This is an autoimmune condition and makes the pancreas stop producing insulin. Some probable causes of type 1 diabetes are:

1. Family history of diabetes

2. Pancreatic diseases

3. Other infections and diseases that can affect the pancreas.

Between the two, type 2 diabetes is more common. Type 2 diabetes is also known as insulin resistance and can affect a person at any stage in life. However, it is more common amongst men and women above the age of 45. Ethnicity also plays an important role here with African Americans, Latino Americans, Asian Americans and Hispanic people being more vulnerable to this disease. In this case, the body does produce insulin but either this amount is insufficient or the body is resistant to the insulin. Some factors that can trigger this condition are:

1. Obesity

2. High blood pressure

3. Sedentary lifestyle

4. Polycystic ovary syndrome

5. Family history of diabetes

6. Low levels of good cholesterol and high levels of triglycerides

7. Presence of cells that are resistant to insulin

8. Prediabetes or glucose intolerance

The most common symptoms of type 1 and type 2 diabetes are:

1. Increased urination

2. Excessive thirst and increased appetite

3. Weight loss

4. Fatigue

5. Wounds that are slow to heal

6. Yeast infections

7. Numbness and tingling sensations in the toes

8. Dry skin

9. Blurred vision

10. Nausea and vomiting

Another common type of diabetes is known as gestational diabetes Gestational diabetes affects pregnant women. It is caused by the over or under production of insulin by the placenta. Gestational diabetes can affect the health and growth of the baby is not treated in time. This condition usually resolves itself after the baby is delivered but it can put the mother at an increased risk of suffering from type 2 diabetes. Some factors that can trigger this condition are:

1. Obesity

2. Glucose intolerance

3. Family history of diabetes

4. Pregnancy after the age of 30 

   If you wish to discuss about any specific problem, you can consult an endocrinologist.

Good afternoon everybody. I am Dr Anirban Biswas and I am a diabetologist, practising in South Delhi. Today we are going to discuss the screening and diagnosis of Prediabetes and Diabetes.

Most of my patients send me their reports and tell and that they have a fasting sugar of 128 and a PP sugar of 142, whether they are diabetic or not. So, by listening today's topic, you will be able to know whether you are a diabetic or not. Let me tell you first that diabetes is a deadly disease and as you all know that India is a diabetic capital of the whole world. Every 7th second, one person dies due to diabetes in this world. And it is a huge burden on us. And most of the diabetic care and treatment is born by the patients in India. On an average Rs, 10,000 per year is the annual cost of the treatment without any complication. So, it is a huge amount, hence, we need to find out whether we have diabetes or not.

So, the first thing is that whether you have diabetes or not. So, the first question is that if anybody can have diabetes? So the answer to this question is that, yes anyone can suffer from Diabetes. There are some symptoms of Diabetes, those are;

• Weight loss
• Lethargic
• Thirst
• Excessive urination

But often, diabetes is silent. It has been found out by various researchers that half of the population does not know that they are diabetic patients. Not only in India but also in the US. It is very important to find out that who are diabetic. It is a very simple way to find out whether you are diabetic, pre diabetic or have normal sugar level.

The value what I am going to tell you that how you get to know that you are diabetic.

• First thing is the fasting blood glucose. This can be done in any lab. So, you can go in the morning without taking any meal. One thing you need to remember that if your fasting blood glucose is less than 100 then it is normal. If your fasting blood glucose is between 100-126 mg then you are prediabetic. And if the fasting blood sugar is more than 126 then it means that you are a diabetic patient.
• The second way to know whether you are diabetic or not is the HBA1C. It is also known as Glycosylated Haemoglobin. Again it is a routine test which is done in all the labs. If the value of HBA1C is below 5.7 then you are non-diabetic, if the HBA1C level is between 5.7- 6.5 then you are prediabetic. And if the HBA1C level is above 6.5 then you are a diabetic patient.
• The other test is OSTT, which is done at a certain level when there is some amount of doubt. The Oral GTT test is by means 75 g of glucose is fed to you and the sugar is checked after 2 hours. So, after 2 hours of feeding the glucose, if the sugar level is less than 140 then you are normal. If the sugar level is between 140-200, then you are prediabetic, and if the value is more than 200 then you are diabetic.

Which individual should get screened for diabetic and pre diabetic?

Any individual above the age of 40 years. And from your weight and height, anybody can calculate the BMI ( Body Mass Index). If the BMI is more than 23 then you should go for screening even if your age is not 40+. If you have symptoms of Diabetes, or if any blood relative is having diabetes or is pre-diabetic should go for a checkup.

And last but not the least, who has a history of GDM i.e, Gestational Diabetes Mellitus which is very common in females throughout the whole world, after the pregnancy they should regularly get screened for diabetes. So these are the people who should get screened for Diabetes. And by getting a screen from Diabetes we can save ourselves from the complications of Diabetes.

Diabetes can cause so many complications, especially the cardiac and heart-related complications. You can have a stroke, heart attack, neuropathy, kidney failure, also you can have blindness or retinopathy, amputations i.e, your arm or leg can be cut because of diabetes.

So friends may be with this I can conclude that you have learnt something from my talk. And please remember that you should get yourself screen with diabetes. Next I will talk about the type of Diabetes.

If you want to consult me or have any query, You can contact me through Lybrate.