HealthCare

Can you discuss the potential role of technology and telemedicine in the management of diabetes and hypertension, and how it can improve patient outcomes?

Transforming Diabetes and Hypertension Care: The Power of Technology and Telemedicine

So the question is, can you discuss the potential role of technology and telemedicine in the management of diabetes and hypertension and how can it improve? Patient outcomes. So I feel like the field of Endocrinology lends itself very nicely to telemedicine, particularly, because a lot of what I do is interpretation of data. So with regards to blood pressure, there are 24-hour ambulatory, blood pressure, monitors, that were able to put on patients, which gives us a better sense. Getting a better sense of what their blood pressures are over the course of the day rather than one isolated measurement that when they first show up to the office and their blood pressure is high because they were running late with regards to diabetes. I'll talk a little bit about the technology that's available. Now we have we've insulin pumps and we have continuous glucose monitors or see GM's where patients are able to wear these these sensors where there's a little tiny catheter sitting under the skin. It's constantly sampling, the glucose in the interstitial space and that data is then transmitted to patients iPhones, where they're able to see their blood sugar measurements. You know, every five minutes so rather than having to prick their finger three or four times a day, they're able to wear these sensors which they typically have to change every seven to fourteen days. Although there is one that is implantable that has to be changed every six months. And so the patients can see their real time, you know, Trends in their blood sugars, they're able to set alerts on their phones. That tell them. If they're running high or low, family members can have access to the data, which is really nice when children have type 1 diabetes. And so not only do these blood sugar's improve overall, you know, ones average blood sugar but also improve the time and range and reduce glucose variability. Thanks for the question.

Technology and telemedicine can play a role in the management of diabetes and hypertension by allowing for 24-hour ambulatory blood pressure monitoring, as well as the use of insulin pumps and continuous glucose monitors that can send data to a patient's phone. These technologies can help reduce time and range and improve overall blood sugar levels and glucose variability.

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The potential role of technology and telemedicine in the management of diabetes and hypertension is significant. In the field of Endocrinology, telemedicine is particularly well-suited because a large part of the work involves data interpretation.

For blood pressure management, 24-hour ambulatory blood pressure monitors provide a more comprehensive understanding of a patient's blood pressure throughout the day, rather than relying on isolated measurements taken during office visits.

In terms of diabetes management, there have been advancements in technology. Insulin pumps and continuous glucose monitors (CGMs) are now available. CGMs use sensors placed under the skin to constantly monitor glucose levels in the interstitial space. This data is transmitted to the patient's smartphone, allowing them to see real-time blood sugar measurements and trends. Instead of frequent finger pricks, patients can wear these sensors, typically changing them every seven to fourteen days. Some even have implantable options that only need to be changed every six months. This technology not only improves average blood sugar levels but also enhances time in range and reduces glucose variability.

Patients can set alerts on their phones to notify them if their blood sugar levels are too high or too low. Additionally, family members can have access to the data, which is particularly helpful for children with type 1 diabetes.

Overall, technology and telemedicine play a crucial role in improving patient outcomes by providing more accurate and real-time data for effective management of diabetes and hypertension.

Can you explain the role of insulin and other medications in the treatment of diabetes?

Insulin & Medications: Key Players in Diabetes Treatment

So, can you explain the role of insulin and other medications in the treatment of diabetes? Yes. So what is insulin? It's a hormone made by the beta cells in the pancreas, arise in sugar or glucose is the stimulus for insulin release. Insulin is what we call an anabolic hormone and that it helps the body to turn the carbohydrates from the food that we eat into energy. And so, it does this by stimulating glucose, uptake into fat and muscle and storing excess glucose as something called glycogen in the liver that can be used. For energy in the fasting State, people who have type 1, diabetes are insulin deficient and generally have to start taking insulin as soon as they're diagnosed. Although this is not always the case with type 2 diabetes. These patients generally have insulin resistance such that their bodies are not responding appropriately to insulin. Sometimes these patients do need to go on insulin, but generally I prefer to try non-insulin agents first. That may also have other non glycemic benefits as well. So sulfonylureas are pills that Are effectively like taking insulin, but they just cause one's own body to release more endogenous insulin. They do lose efficacy over time and have a risk of hypoglycemia or low blood sugar levels and they can also lead to weight gain. Metformin, is a very effective medicine which works by inhibiting gluconeogenesis. Meaning it lowers blood sugar levels by preventing the liver from inappropriately. Making new glucose patients often lose weight and the risk of hypoglycemia is really low. So it's Generally one of the first medicines, we try the glp-1 receptor Agonist take advantage of something called the in curtain effect which is mediated by hormones made in the gut in response to the ingestion of food so they're very effective at preventing postprandial. Post, eating blood glucose Rises and they often lead to weight loss. And then finally, the sglt2 Inhibitors are medicines that cause the kidneys to excrete more glucose in the urine. And so they're also very effective. Thanks.

Insulin is a hormone made by the pancreas which helps to turn carbohydrates into energy. People with Type 1 diabetes require insulin injections, while those with Type 2 diabetes may require non-insulin medications such as sulfonylureas, metformin and glp-1 receptor agonists or sglt2 inhibitors. These non-insulin medications can help to lower blood sugar levels and can also lead to weight loss.

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The role of insulin and other medications in the treatment of diabetes is as follows:

Insulin is a hormone produced by the pancreas that helps convert the carbohydrates from food into energy. It stimulates the uptake of glucose into fat and muscle cells and stores excess glucose as glycogen in the liver for later use. People with type 1 diabetes, who are insulin deficient, typically need to start taking insulin as soon as they are diagnosed. However, in type 2 diabetes, where there is insulin resistance, non-insulin agents are often tried first.

Sulfonylureas are pills that stimulate the release of more insulin from the body's own cells. They can be effective but may lose efficacy over time and carry a risk of hypoglycemia and weight gain.

Metformin is a commonly used medication that inhibits the liver from producing excess glucose, thus lowering blood sugar levels. It is often one of the first medicines prescribed and has the added benefit of potential weight loss with a low risk of hypoglycemia.

GLP-1 receptor agonists take advantage of the incretin effect, which involves hormones released in response to food ingestion. These medications help prevent postprandial (after-meal) blood glucose spikes and often lead to weight loss.

SGLT2 inhibitors work by causing the kidneys to excrete more glucose in the urine. They are also effective in lowering blood sugar levels.

These are just some of the medications used in diabetes treatment, and the choice of medication depends on individual factors and the specific needs of the patient.

What are some health risks of hormone treatment related to male to female transitions?

Health risks of hormone treatment for male to female transitions: risks and benefits

What are some health risks of hormone treatment related to male to female transitions. So gender dysphoria is the persistent in congruence between one's gender identity and one sex assigned at Birth for transgender and gender diverse individuals. Gender, affirming hormone therapy can be prescribed by a healthcare professional. That will produce physical changes in the body, so that the body more closely aligns with one's gender identity. So, feminizing hormone therapy typically involves prescribing a medicine that either. Either lowers or blocks the effects of testosterone and then estrogen to induce female, secondary sex characteristics. So, with spironolactone, it is also a blood pressure medicine, and it can sometimes increase potassium levels. So these things have to be monitored. Looper light is a another medicine that lowers testosterone levels. It's typically more expensive and it's given as an injection. Every few months estrogen can be given as a pill, as a patch, as an injection. There is Evidence that it can increase the risk of blood clots, which can be in the Deep veins in the legs and that can also travel to the lungs. There may be a cardiovascular risk. Estrogen has been associated with weight, gain with an increase in prolactin levels and with an increase in high blood pressure, there's some evidence that the transdermal approach using an estrogen patch may be the safest option and at least likely to cause blood clots. So that's typically the option that I like to offer. Or my patients, patients, should discuss these risks and benefits with their doctors and make sure that these risks are optimized. So, you know, to maintain good blood pressure. Optimal way to avoid tobacco and you know, I'd encourage you to check out the new world professional association for transgender health or W path 8, standards of care version 8 which was recently published and has some great information. Thanks for the question.

Hormone treatment related to male to female transition can have some health risks associated with it, such as increased risk of blood clots, cardiovascular risk, weight gain, increased prolactin levels, and high blood pressure. Patients should discuss these risks and benefits with their doctor in order to minimize them, and make sure to maintain good blood pressure and avoid tobacco. W Path 8 standards of care version 8 can provide more information on this topic.

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The health risks associated with hormone treatment for male to female transitions should be considered. Gender dysphoria, the incongruence between gender identity and assigned sex at birth, can be addressed through gender-affirming hormone therapy prescribed by healthcare professionals. Feminizing hormone therapy typically involves medications that lower or block testosterone and introduce estrogen to develop female secondary sex characteristics.

Spironolactone, a blood pressure medication used in hormone therapy, may increase potassium levels and requires monitoring. Lupron Depot is another medication that lowers testosterone levels and is administered through injections every few months. Estrogen can be taken as a pill, patch, or injection. It's important to note that estrogen use has been associated with potential risks such as blood clots, weight gain, increased prolactin levels, and high blood pressure. Transdermal estrogen patches may be the safest option with the lowest risk of blood clots.

Patients should have open discussions with their doctors about these risks and benefits to ensure optimal management. Maintaining good blood pressure and avoiding tobacco are important factors to consider. The World Professional Association for Transgender Health (WPATH) has published the Standards of Care Version 8, which provides valuable information on this topic.

It's essential for individuals undergoing hormone treatment to be well-informed and work closely with their healthcare providers to optimize their care and minimize potential risks.

What are the signs/symptoms of adrenal fatigue and potential options for treatment?

Unveiling adrenal fatigue signs, symptoms, and treatment options.

Hi, thanks for the question. So what are the signs and symptoms of adrenal fatigue and potential options for treatment? So our adrenal glands are little triangular shaped glands that sit on top of the kidneys. And one of the hormones that the adrenals make is cortisol, which is our stress hormone. It helps to maintain blood pressure, it helps to maintain our immune systems, it helps to maintain our blood sugar levels. So it's really important, especially in the setting of stressful situations. The rule of thumb in endocrinology is that if you think somebody is deficient in a hormone, you wanna try and test it at the time of day that you think it should be highest. Cortisol secreted in a diurnal fashion, which means it's its highest first thing in the morning when we wake up, and then it tapers down over the course of the day into the night. So if I think that somebody has adrenal insufficiency because they have fatigue, nausea, unintentional weight loss, low blood pressure, low blood sugar, I will check an 8 a.m. fasting cortisol level to see, you know, is it low. In situations where we're not totally sure, we can do what's called a cosyntropin stimulation test, where you give somebody a synthetic hormone that mimics ACTH, which is the pituitary hormone that tells the adrenal glands to make cortisol. And after that test is done, we expect cortisol levels to rise. If they don't rise, then that suggests that there's a problem with the adrenal glands. And then we can make the diagnosis of adrenal insufficiency. And then the treatment would be giving somebody glucocorticoids back, like prednisone or hydrocortisone. Adrenal fatigue is not a recognized condition by the medical community. So I would not treat somebody just for adrenal fatigue, but I definitely would give them steroids if I did make the diagnosis of adrenal insufficiency. Thanks.

Adrenal fatigue is not a recognized condition, but adrenal insufficiency is and can be diagnosed by testing a fasting cortisol level in the morning or a cosyntropin stimulation test. Treatment would involve taking glucocorticoids like prednisone or hydrocortisone.

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The signs and symptoms of adrenal fatigue can include fatigue, nausea, unintentional weight loss, low blood pressure, and low blood sugar. To assess adrenal function, cortisol levels are typically tested. Cortisol is highest in the morning and decreases throughout the day. If cortisol levels are consistently low, it may indicate adrenal insufficiency.

To confirm the diagnosis, a cosyntropin stimulation test can be conducted. This involves administering a synthetic hormone that mimics ACTH, which stimulates cortisol production. If cortisol levels do not rise appropriately, it suggests a problem with the adrenal glands, leading to a diagnosis of adrenal insufficiency.

Treatment for adrenal insufficiency involves replacing the deficient hormones with glucocorticoids like prednisone or hydrocortisone. It's important to note that adrenal fatigue is not recognized as a medical condition by the medical community. Therefore, treatment would not be provided solely based on the concept of adrenal fatigue. However, if adrenal insufficiency is diagnosed, appropriate treatment with steroids would be administered.

It's always advisable to consult with a healthcare professional for an accurate diagnosis and appropriate treatment options.

What are some negative after effects of stopping the usage of steroids, HGH, and other “bolstering” substances?

Negative Effects of Stopping Steroid Use: A Vicious Cycle

So what are some of the negative effects of stopping using steroids, HGH and other bolstering substances? So what this question is getting at is what happens when typically a man, although there are cases of women as well, stop using anabolic androgenic steroids. Typically they've been using them because the patients are trying to bulk up and to gain muscle mass that's much greater than anything that could be achieved physiologically at the gym. The problem with anabolic steroids is that over time they're terrible for the heart, they're terrible for the liver, for the skin, they lead to gynecomastia, testicular atrophy, thus affecting fertility. So the problem is these super physiologic doses of steroids suppress the hypothalamic pituitary gonadal axis. So if men try and stop anabolic steroids cold turkey, they have what's called anabolic steroid induced hypogonadism where their own body has been hibernating and it's gonna take a while, if ever, for their own axis to wake up and to start producing testosterone again. And this can lead to significant fatigue, low libido, depression, and it's a vicious cycle where it makes it very difficult to stop these agents. So sometimes I have to put somebody on testosterone or a medicine called clomiphene which kind of helps their own hypothalamic pituitary axis to wake up again so that they would hopefully start to produce some of their own endogenous testosterone rather than me just replacing the testosterone that's missing. Thanks for the question.

Stopping the use of steroids, HGH and other performance-enhancing substances can lead to anabolic steroid induced hypogonadism which can cause significant fatigue, low libido, depression. Doctors may have to put patients on testosterone or a medicine called clomiphene to help the hypothalamic-pituitary-adrenal access wake up again and start producing endogenous testosterone.

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The negative effects of stopping the usage of steroids, HGH, and other bolstering substances primarily affect individuals, typically men, who have been using anabolic androgenic steroids to gain muscle mass beyond what is achievable naturally. These substances can have detrimental effects on the heart, liver, skin, and can lead to gynecomastia and testicular atrophy, impacting fertility. When individuals abruptly stop using anabolic steroids, they may experience anabolic steroid-induced hypogonadism. This means that their body's natural production of testosterone has been suppressed, and it may take a significant amount of time, if ever, for their hormonal axis to recover and testosterone levels to normalize. This can result in fatigue, low libido, depression, and create a challenging cycle for individuals trying to discontinue these substances. In some cases, medical interventions such as testosterone replacement therapy or medications like clomiphene may be necessary to help stimulate the body's own testosterone production.

What are some common warning signs of diabetes?

Warning signs of diabetes: Increased thirst, urination, weight loss.

So what are some common warning signs of diabetes. So our kidneys are very good at reabsorbing, the glucose that's filtered in the blood. Although once the serum glucose exceeds a certain threshold above around 180 milligrams per deciliter just overwhelms the kidneys ability to reabsorb that glucose. So you start to spill glucose into the urine, wherever glucose goes, water follows and so patients start to have what's called an osmotic diuresis where they are just Losing lots and lots of sugar and water, which is very dehydrating. So one of the most common symptoms that patients will tell me is that they are having increased thirst and urination and also because they're losing calories in the urine. They may also have an unintentional weight loss. This these fluid shifts can also happen in the lens of the eye. So it's not uncommon for patients to have blurry vision. They may also report fatigue or headaches if people don't really feel well when they're when their blood sugar is high and then once we make that diagnosis, they understand why they haven't been feeling well. So those are some of the common signs and symptoms that I look for. Thanks for the question.

Common warning signs of diabetes include increased thirst and urination, unintentional weight loss, blurry vision, fatigue, and headaches.

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Common warning signs of diabetes include increased thirst and urination. When blood sugar levels exceed a certain threshold, the kidneys are unable to reabsorb glucose effectively, leading to glucose spilling into the urine. This results in an osmotic diuresis, causing excessive loss of sugar and water, leading to dehydration.

Patients may also experience unintentional weight loss due to the loss of calories in the urine. Fluid shifts can occur in the lens of the eye, causing blurry vision. Fatigue and headaches are also common symptoms, as individuals generally do not feel well when their blood sugar is high.

These are some of the key signs and symptoms that indicate the possibility of diabetes.

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Dr. Anna L. Goldman is an endocrinologist in Foxboro, Massachusetts, and is affiliated with Brigham and Women's Hospital. She received her medical degree from the Perelman School of Medicine at the University of Pennsylvania.

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Dr. Anna Goldman, MD