Diabetes: Don’t Sugar Coat it

Understanding Diabetes Mellitus

Diabetes mellitus, or simply diabetes, is a metabolic condition that is characterised by high blood sugar levels. This is caused by a lack or ineffective use of a hormone known as insulin. This hormone transports sugar to your cells from the blood stream where it is stored for energy production. When there is not enough insulin or your body does not use it effectively, the sugar remains in the blood. If untreated, diabetes can cause damage to your eyes, kidneys, nerves and other organs. There are different types of diabetes mellitus, such as: Type 1 diabetes: This is an autoimmune condition where your immune system attacks the pancreatic cells that make insulin, resulting in decreased insulin production. Type 2 diabetes: This condition occurs when your body becomes resistant to insulin, causing sugar levels in your blood to go up. Gestational diabetes: This is seen in pregnant women. Their placentas produce insulin-blocking hormones which cause high blood sugar levels. Diabetes insipid us: This is unrelated to diabetes mellitus and a much rarer condition. It is caused by overworking kidneys which remove too much fluid from your body.

What are the symptoms of Diabetes?

Most symptoms are common to the different types of diabetes mellitus. They are:

• Increased hunger and thirst
• Frequent urination
• Weight loss
• Blurry vision
• Extreme fatigue
• Delayed healing of wounds and sores
• In initial stages diabetes often goes unnoticed as there are no symptoms.

What causes diabetes mellitus?

Doctors are uncertain regarding the cause of type 1 diabetes, mainly because it is an autoimmune condition. With type 2 diabetes, the most common factors are genetics and lifestyle. It is a hereditary condition, which means that you have a high chance of being diabetic if your parents have the disease. Being obese and overweight and leading a physically inactive lifestyle can greatly increase your chances of developing diabetes.

Treatment

Type 1 diabetes is generally treated with insulin. Type 2 diabetes can be managed through regular physical exercise and following a low-sugar diet. If lifestyle changes are not enough to bring down your blood sugar levels, your doctor will prescribe medication to manage diabetes. It is important to keep your blood sugars under control to prevent long term damage to your kidneys, eyes, nerves, heart and other organs.

Hypertension the Silent Killer

What is Hypertension?

Hypertension is the medical term for high blood pressure. The force exerted on the major blood vessels in your body by blood flow is calculated as blood pressure. It is mentioned in two numbers - systolic and diastolic. The systolic number represents the pressure created by the heart when it beats or contracts. The diastolic number represents the pressure in the blood vessels when the heart is resting between beats. Hypertension is long-term high blood pressure and can lead to a variety of health problems like heart disease, heart attack and stroke. It is important to keep your blood pressure under control to reduce the risk of developing these problems. If left unchecked, hypertension can make you critically ill and even cause death.

What are the causes of Hypertension?

There are two types of hypertension - primary and secondary. Primary hypertension has no identifiable cause and often develops as people grow older. Secondary hypertension is commonly caused by underlying conditions, such as:

• Kidney problems
• Obstructive sleep apnea
• Thyroid problems
• Tumours in the adrenal glands
• Congenital defects of the blood vessels
• Reaction to certain medication such as cold remedies, birth control pills and painkillers
• Drug use

Some risk factors that can increase your chances of developing hypertension include:

• Age
• Family history
• Sedentary or lazy lifestyle
• Obesity or being overweight
• High-salt diet
• High consumption of alcohol
• Smoking
• Stress
• Chronic conditions like diabetes and kidney disease

Treatment and management

The first line of treatment for hypertension is making lifestyle changes. This includes following a regular physical exercise regime and eating a healthy, fibre-rich diet. People with hypertension are suggested to follow low-salt diets. Quitting smoking and reduced alcohol consumption can also bring down blood pressure levels. Managing or avoiding stress can have a positive impact on your hypertension. Yoga, warm baths, taking long walks and meditation can bring down your blood pressure. If necessary, your doctor can prescribe antihypertensive medication to manage blood pressure levels.

Know More about Gastrointestinal Bleeding (GI )

What is GI bleed?

A GI or gastrointestinal bleed is a symptom of a disorder affecting your stomach or intestines. The bleed can occur anywhere in your gastrointestinal tract and is normally seen in vomit or stool. A GI bleed can range from mild to severe but it is important to seek medical treatment regardless of the level. Modern imaging technology such as CT scans and ultrasounds are often used to determine the area and cause of a GI bleed.

What are the symptoms of a GI bleed?

The symptoms of a GI bleed can be hidden (occult) or obvious (overt) and they depend on the area of the bleed, which can be located anywhere between the mouth and anus. The rate of bleeding also affects the symptoms. Some of the most common obvious signs of GI bleeding are:

• Black or tarry stool
• Bright or dark red blood present in stool
• Bright red blood present in vomit
• Vomit that looks like coffee
• Abdominal cramps and pain
• Generalized weakness due to anaemia

Occult symptoms include:

• Difficulty breathing
• Lightheadedness
• Fainting
• Chest pain

Abrupt and rapidly progressing GI bleeding can cause a person to go into shock, and the symptoms include rapid pulse, drop in blood pressure and unconsciousness. What are the causes of GI bleed? Gastrointestinal bleeding is generally categorised as upper and lower GI bleed. The causes include:

• Peptic ulcers
• Oesophageal varices
• Oesophageal Ulcers
• Oesophagitis
• Diverticular disease
• Proctitis
• Inflammatory bowel disease
• Colon polyps
• Tumours
• Anal fissures
• Haemorrhoids

GERD or gastroesophageal reflux disease is a condition where the lower end of esophageal eroded by acid from stomach and can result bleeding. Heavy alcohol consumption and smoking also makes one more prone to developing GI bleeds. Some serious GI bleeding cases may require surgery, while others are treated with oral medicines.

Ercp – Endoscopic Retrograde Cholangiopancreatography

What is ERCP?

ERCP or endoscopic retrograde cholangio-pancreatography is a diagnostic procedure that allows physicians to examine your bile and pancreatic ducts and liver using an endoscope. It is generally performed to diagnose and treat problems regarding theseorgans. ERCP may also be used to assist during gallbladder surgery, remove bile stones and obtain biopsy material in the case of tumours. This test is sometimesused to diagnose and treat complications following gallbladder surgery.

How is ERCP performed?

Before the procedure, the patient is given general anaesthesia to make them comfortable. After they have been sedated, the endoscope is inserted into the food pipe through the mouth. It is advanced into the stomach, allowing the physician to examine its contents and surrounding areas. The doctor can also examine the first of the small intestine, biliary tree and pancreatic duct during the test. If required, contrast materials are injected so images of the pancreatic and bile ducts can be captured. Besides a light and camera device, the endoscope also contains specialised tools to make small cuts and acquire tissue material for biopsies, remove stones in biliary tree. Before undergoing ERCP, the patient’s stomach must be empty. They are instructed not to consume solid food during the evening and night,preferably at least 8 hours before the procedure. Any necessary medication should be taken with very little amount of water. The patient is also required to bring a companion so they can be taken home after the procedure.

Why is ERCP performed?

Your biliary tree and pancreas and bile ducts can be affected by various diseases. Your doctor will suggest an ERCP test if you are facing any of the following symptoms:

• Blocked bile ducts due to cancer, tumours, gallstones or compression from neighbouring organs
• Recurrent or persistent abdominal pain that could not be diagnosed by other tests such as CT or MRI scans
• Jaundice due to obstructed biliary tree
• Symptoms of pancreatic cancer

Consult your doctor you are experiencing any gastroenterological symptoms and need more information on ERCP.

Endoscopy – A Minimally Invasive Procedure

What is Endoscopy?

Endoscopy is a medical procedure where a long, thin tube is inserted into the body, mainly through the mouth, to observe tissue and internal organs for diagnosis and treatment. It is also used for minor surgery and imaging purposes. This minimally invasive procedure is a highly effective diagnostic test, especially when other tests have been unsuccessful. Modern endoscopy presents almost no risks and is able to deliver crystal clear images, making it an effective tool for diagnosis and treatment. It is also quick and easy to carry out, which is why most doctors prefer this diagnostic test over others.

What does Endoscopy involve?

Endoscopy is a minimally invasive procedure, so an overnight stay is not required. It typically takes 1 hour to complete, but the duration depends on the patient’s condition. For most endoscopy procedures, the patient is advised to fast for at least 12 hours prior to the test. For gut endoscopy tests, the patient is given a laxative the previous night to clear out the system. The procedure is generally performed while the patient is conscious, but anaesthesia may be given in specific cases. During the procedure, a thin tube is inserted into the mouth and advanced into the stomach through the food pipe. The tube contains a small camera and light source that allows the doctor to visualise the inside of the stomach and its contents. If necessary, it can be advanced into the intestines, liver and pancreas during the same procedure as well. Endoscopy is also used during surgical procedures to make them less invasive. Procedures such as tubectomy, gallbladder removal and the removal of small tumours are often performed using endoscopy. A modified endoscopy known as a laparoscope is used during keyhole surgeries. Endoscopy is a safe procedure performed on millions of people around the world every year. Talk to your doctor today for more details on this procedure.

Screening of Colon/Rectal Diseases through Colonoscopy

What is Colonoscopy?

A colonoscopy is a minimally invasive procedure where a long, thin tube is inserted into the colon for the detection of abnormalities or diseases in the large intestine. The tube, called a colonoscope, contains a small video camera which allows the physician to visualise the inside of the colon. Besides diagnostics, colonoscopy is also used to remove polyps and other abnormal tissue as well as acquire material for biopsies.

What happens during a Colonoscopy?

Before the colonoscopy procedure, the patient’s intestines need to be cleaned out. This is done either by taking a laxative or undergoing an enema. The patient is advised against consuming solid food during the day prior to the procedure. During the procedure, a sedative is given to the patient to keep them comfortable. They are made to lie on the exam table with their knees folded to their chest. The colonoscope is then inserted into the rectum and carbon dioxide gas is pumped into the intestines. This causes the intestines to become inflated and allows easy visualisation. The physician studies the insides of the colon and intestines for any abnormalities. Tissue samples may also be extracted for biopsies. The colonoscope also contains specialised tools that allow the removal of polyps and other abnormal tissue. A typical colonoscopy procedure takes between 30 to 60 minutes. The patient can go home the same day and can resume regular activities the following day.

When is a Colonoscopy required?

The intestines are as susceptible to many conditions just like the rest of your body. Your doctor may recommend a colonoscopy during any of the following cases:

• To check for colon cancer, especially in people older than 50 years. Doctors recommend colonoscopies every 10 years to screen for cancer.
• To identify and remove polyps growing inside the intestines. Removing polyps helps reduce the risks of colon cancer
• To investigate signs and symptoms of intestinal conditions such as rectal bleeding, abdominal pain, chronic diarrhoea or constipation etc.

Common Types Bowel Disorders

Bowel disorders are conditions that affect your small intestine, large intestine and other parts of the digestive system. They affect your body’s ability to digest food and absorb nutrition. Bowel disorders mostly present themselves through uncomfortable symptoms like constipation and diarrhoea, but they can lead to more serious complications if left untreated.

Are there types of bowel disorders?

Your digestive system can be affected by a variety of bowel disorders. Some of the most common ones are: Irritable bowel syndrome (IBS): This condition affects both your large and small intestines and causes frequent uncomfortable symptoms that can interfere with your daily life. Celiac disease: This autoimmune disorder is brought on by a negative reaction to gluten, which is commonly found in barley and wheat. This condition causes an irritation in the small intestine’s inner lining when you eat gluten. Crohn’s disease: This autoimmune inflammatory disease is characterised by tissue damage in mouth, intestines and anus. Intestinal obstruction: This occurs when the intestines become blocked due to polyps or tumours, preventing normal food processing and bowel movements. Ulcers, intestinal cancers and infections can also cause similar symptoms as bowel disorders. The key to treatment is proper diagnosis.

What are the symptoms of bowel disorders?

Symptoms of bowel disorders can vary from one person to another. Here are the most common ones:

• Nausea
• Vomiting
• Constipation
• Diarrhoea
• Pain or discomfort in the abdomen
• Abdominal bloating and gas

More serious symptoms include sudden weight loss and high fever. If your stool or vomit shows signs of blood, contact your doctor at once.

How are bowel disorders treated?

If you have Crohn’s disease or IBS, your doctor can give you some medicines to alleviate your symptoms. Intestinal blockage or Crohn’s disease may sometimes require surgery. The best way to treat bowel disorders is by eating a healthy diet. A strict gluten-free diet is necessary for people with celiac disease. Avoiding foods that trigger symptoms is another way of keeping bowel disorders at bay.

URS, Laser Lithotripsy and DJ Stenting

URS

URS or ureteroscopy is a minimally invasive surgical procedure where a small telescope or ureterscope is inserted into the ureter via the urethra to remove stones. The stones are broken down into smaller pieces using a laser. These fragments are then removed using the grasping devices. URS has a very high success rate of removing stones in the lower and upper ureter as well as the kidneys. Only about 15% of the cases may need additional intervention.

Laser lithotripsy

Laser lithotripsy is a non-invasive procedure where a laser is used to break apart stones within the urinary tract. The fragmented stones are either removed using a ureteroscope or passed out of the body through urine. Laser lithotripsy is performed if other non-surgical treatments for kidney stones have failed. The procedure is also performed if the kidney stones are too large, irregularly shaped or are causing damage to the surrounding tissue. Laser lithotripsy is often performed in combination with ureteroscopy or URS.

DJ stenting

A DJ or double ‘J’ stent is a small tube that is placed in the area between the kidney and urinary bladder to ensure that the ureter is open and free from blockages. The unique shape and structure of the DJ stent allows the ureter to retain its shape and urine to pass through. The stent is used to help the ureter dilate and prevent strictures or narrowing of the tube. A DJ stent is typically put in place after the treatment of kidney stones. Once the stones have been broken down, the stent is inserted to prevent any complications during the healing process. The stent also plays a role in the passage of kidney stone fragments.

TURP- Transurethral Resection for Enlarged Prostate

What is TURP?

TURP or transurethral resection of the prostate is a surgical procedure where enlarged, obstructing portion of the prostate is removed. It is performed to treat urinary issues that arise due to an enlarged prostate. The prostate is a small gland located in the pelvis and found only in men. It surrounds the urethra and is situated between the bladder and penis. When the prostate becomes enlarged, it exerts an increased amount of pressure on the urethra and bladder. This can affect the person’s urination and cause severe discomfort.

Why is TURP performed?

Your doctor will suggest TURP if you start showing symptoms of benign prostatic hyperplasia or prostate enlargement. This condition can cause troublesome symptoms and sometimes fail to respond to medication. Some of the symptoms of an enlarged prostate include:

• Problems with starting to urinate
• Weak urine flow
• Discontinuous urine flow with frequent stopping and starting
• Frequent need to urinate, sometimes during the night (nocturia)
• Sudden urge to urinate
• Having to apply more pressure than normal to urinate
• Unable to empty the bladder completely

These symptoms can be corrected if you undergo TURP.

What happens during a TURP procedure?

TURP is minimally invasive procedure that requires spinal or epidural anaesthesia. During the procedure, a thin metal tube called a resectoscope is passed to your prostate through the urethra. The resectoscope comes attached with a loop of wire, camera and a light, which allows the doctor to be able to visualize the affected area. The wire loop is heated using electric current and used to remove a section of the prostate. A catheter is inserted and fluid is pumped into the bladder to flush out any blood clot that may have freshly formed. If you are facing difficulties with urination, consult a urologist today.