Dr. Milind Patil

Diabetes is one major silent killer. Depression is another silent killer. According to the studies, a patient with diabetes has higher chances of getting depressed. Lack of social support, staying alone, lower income, the presence of diabetes complications and poorly controlled diabetes increase chances of depression in diabetes patients. Similarly depressed patient is at increased risk of development of diabetes. Thus, depression and diabetes have a cyclic relationship.

Need to break

It is very important to break the vicious cycle as it can affect the sugar control, quality of life and patient care. The depressed patient is less likely to follow diet and exercise. They do not take medicines regularly. The depressed patients will have bad control of sugar and increased complications of diabetes. It affects the quality of life of the patient.

How we can break the cycle?

1. Speak out

Depression remains underdiagnosed and untreated. One of the reason is the stigma associated with psychiatric illness in the society. Unless and until patient doesn't talk about it they are not going to improve. Hence ADA recommends evaluating for depression in patients with poorly controlled diabetes.

2. Psychotherapy

Psychotherapy or in particular cognitive behavioral therapy has been proven beneficial towards treating depression.

3. Regular Exercise

Regular exercise is very beneficial towards treating, both depression and diabetes. Exercise helps regulate blood sugar levels and hence can help control diabetes. It also helps in reducing excess weight, which can enhance your self-image and make you feel happier. Simultaneously, it also releases endorphins or the 'feel good' brain chemical. This can help alleviate depression symptoms.

4. Antidepressant

These are the medicines given to improve depression. Under the guidance of a psychiatrist, they help a lot. So don't say no to these medicines when prescribed by the psychiatrist.

Do you have an extremely low reading of thyroxine or T4, it means that you are suffering from an under active thyroid disease called hypothyroidism. With this condition, your thyroid glands fail to make sufficient thyroid hormones. The thyroid gland releases hormones, which travel all over your bloodstream and affect all parts of the body. Thyroid controls how the cells of the body use energy from food via the metabolism process, which in turn affects the body’s temperature, heartbeat and burning of calories. Lack of thyroid hormones slows down the body’s functions, reduces your energy and the metabolism is disrupted.

Causes of hypothyroidism
The primary cause of this condition is Hashimoto’s thyroiditis. Thyroiditis refers to an inflammation of your thyroid gland. Hashimoto’s thyroiditis is an autoimmune disorder in which extra antibodies are produced which destroy the thyroid gland. Viral infections may also lead to thyroiditis.

Other causes of the condition are as follows:

1. Radiation therapy to the neck region for the treatment of several cancers like lymphoma may damage the cells present in the thyroid gland. Hence, the gland cannot secrete hormones properly.
2. Radioactive iodine treatment is undertaken by people having an overactive thyroid gland. Radiation destroys the thyroid gland cells and leads to hypothyroidism.
3. Certain medicines used to treat heart problems, cancer and psychiatric diseases may affect the thyroid gland and lead to hypothyroidism.
4. Surgeries undertaken for removing the thyroid also lead to hypothyroidism.
5. Iodine is required by the thyroid gland to produce hormones. A low amount of iodine in your diet and body may lead to hypothyroidism.

Risks factors of hypothyroidism
Usually women, especially older women are more likely to get hypothyroidism than men. The factors which determine if you are at a risk of acquiring the condition are as follows:

1. Race
2. Age
3. Premature graying of hair
4. Autoimmune disorders like type 1 diabetes, rheumatoid arthritis, vitiligo, celiac disease, Addison’s disease and many more.
5. Bipolar disorder
6. Turner’s syndrome
7. Down’s syndrome

The symptoms of hypothyroidism are as follows:

1. Changes in menstrual cycle
2. Constipation
3. Hair loss and dry hair
4. Fatigue and tiredness
5. A slow heart rate
6. Depression
7. An increased sensitivity towards cold
8. Swelling of the thyroid gland or goiter
9. Gaining weight unusually or great difficulty in losing weight
10. Carpal tunnel syndrome

If you observe the symptoms of hypothyroidism, you should consult a doctor who will prescribe several blood tests, such as the thyroid stimulating hormone test and the T4 or thyroxine test. Based on the results, a treatment method is adopted.

The body functions are controlled by hormones which are produced by various endocrine glands (named so because these glands secrete hormones directly into the body). There are various endocrine glands, and these are controlled by the master endocrine gland which is the pituitary gland.

The pituitary gland produces prolactin which helps regulate milk production when a woman is breast-feeding. To a smaller extent, it also has some effect on other hormones.

Prolactinoma is a benign tumour of the pituitary gland which produces large amount of prolactin. The cells in the pituitary gland multiply to produce large amounts of prolactin. In people with prolactinoma, there are reduced amounts of oestrogen in females and testosterones in males.

Causes: Though the cause is unknown, a genetic connection believed to exist. They can develop in men as well.

Types: Depending on the size of the tumour, the tumour is of two main types—microprolactinoma (when the tumour measures less than 10 mm) and macroprolactinoma (when the tumour measures more than 10 mm).

Signs and symptoms: Though the most important function of prolactin is the regulation of breast milk production, it also has various other functions in both men and women. The symptoms, therefore, would depend on the gender and the age group.

Men: Reduced libido, erectile dysfunction, reduced fertility, and gynecomastia and sometimes even production of milk.

Women: Menstrual disorders, including lack of periods or irregular periods, reduced fertility, reduced libido, increased facial hair, and spontaneous leakage of milk from the breasts.

In addition to the above symptoms, as the tumour continues to grow, there could be pressure on the surrounding nerves, leading to headaches, blurred of vision, and even double vision. As the tumour grows, the normal pituitary functioning may be affected, and other hormones may not be produced and accordingly the symptoms would appear.

Treatment: 

It is the only pituitary tumor which shrink in size with drugs known as dopamine agonist. Patient might require the treatment for 2-3 years. In some cases surgery and radiotherapy is needed.

So, the answer to the question is yes there is treatment for Prolactinoma and its medicine  in majority of the cases.

Consult your endocrinologist for details!

Diabulimia is a type of eating disorder in which patients of Type 1 diabetes take less amount of insulin purposely, in order to lose weight. These patients have excessive concerns related to body weight and body shape, and a disturbed body image emerges (regarding oneself overweight despite a normal or reduced body weight). These patients attribute too much importance to body weight and body shape and fear of gaining weight. 

Our body requires insulin for moving glucose from the blood to the cells. In type 1 diabetes patients, the pancreas stop producing insulin and glucose gets stored in our bloodstream. Kidney excretes excess glucose leading to increased urination. The body gets devoid of glucose and the calories associated with it and a rapid loss of weight occur.  Once the patient is started on insulin they develop weight gain. Patient with disturbed body image stops insulin in order to lose weight. Patients develop binge eating,  with more emphasis on sugar and carbohydrate enriched foods. The excess sugar gets out of the body by urinating.
Symptoms including excessive thirst, increased water intake, increased urination, and weakness are observed in the early period, irreversible findings including neuropathy, retinopathy, nephropathy, and osteoporosis, which occur in poorly controlled diabetics, are observed in the long term. It has been proven by research that almost 30% of type 1 diabetes patients are the ones who abstain from or avoid using insulin in order to lose weight. This habit leads to the risk of many other fatal diseases which may be permanent in nature.

Prevention

Diabulimia is more common among teenage girls who suffer from type 1 diabetes and are generally obsessed with body image. Proper patient education can help a lot in these patients.  It is advised not to neglect your insulin.