Endocrinology and Metabolic Diseases

Specialty of Endocrinology and Metabolic Diseases Department is Diabetes Mellitus (type 1 diabetes, type 2 diabetes, pregnancy diabetes), obesity, thyroid diseases, parathyroid diseases, hypophyseal diseases, adrenal gland (suprarenal gland) diseases, hirsutism (extreme hairiness), hormone-induced diseases in testicle and ovary, osteoporosis and other metabolic bone diseases, lipid metabolism diseases and rare metabolic diseases.

What is Diabetes?

Most of the food we consume is converted into glucose to be used for energy in the body. This glucose takes part in bloodstream and used as energy in the body. Insulin is a hormone absorbing glucose from bloodstream to the cells in the body and secreted from the organ called pancreas. Glucose passing into blood is absorbed into the cells via insulin hormone. Cells use the glucose as fuel.

Diabetes is a lifelong disease occurring as a result of insufficient insulin hormone secretion from pancreas or inability to use the produced insulin hormone effectively. In diabetes, glucose taken from consumed foods cannot be used, therefore blood glucose increases. This condition is called as Diabetes Mellitus.

Types of Diabetes:

Diabetes has two types:

• Type-1 diabetes: Insulin production from pancreas decreases significantly or ceases in these patients. No insulin is present in blood. Insulin must be supplied externally to balance blood glucose level. It generally occurs in children and young adults in early stages of life.
• Type-2 diabetes: Insulin is produced in pancreas at almost normal levels in these patients till advanced ages. Insulin production can even be above normal levels in some cases. However, insulin cannot provide the sufficient effect. Obesity and malnutrition prevent insulin from showing the desired effect; blood glucose increases. Most of the patients are above 40 years of age and overweight, and have relatives with diabetes.

What are Signs and Symptoms of Diabetes?

Following signs and symptoms are frequently observed in diabetic patients:

• Excessive thirst and dry mouth
• Excessive water drinking
• Excessive urination
• Weight loss
• Excessive appetite and overeating
• Blurred vision
• Weakness, fatigue
• Skin infections
• Non-healing wounds

Who Has Higher Risk of Diabetes?

Diabetes can occur in everyone, however, patients with:

• Familial Diabetes history (parents or children)
• Obesity (BMI > 27 kg/m²)
• Constant physical activity deficiency
• History of Impaired Glucose Tolerance diagnosis
• History of pregnancy diabetes or women giving birth to children above 4 kg
• Hypertension (>140/90 mm Hg)
• 250 mg/dl HDL cholesterol value (blood fat)
• Polycystic over syndrome have higher risk of diabetes.

What Problems Does Diabetes Cause?

Inability to control blood glucose leads to short-term and long-term health problems. Diabetes may cause some damages in small veins, large veins and nerves. These damages are called as complications.

What are Acute Complications of Diabetes?

Diabetes has rapidly-developing and life-threatening conditions. Unless treated quickly and correctly, these conditions may result in death.

Low blood glucose (hypoglycemia): When blood glucose decreases extremely (as a result of excessive drug intake, excessive exercise or insufficient energy intake), person cannot perform normal functions. Hypoglycemia improves rapidly with consumption of sugary fruit juice, cube sugar or granulated sugar.

Ketoacidosis: Ketoacidosis, also called as diabetic coma, is a condition associated with insulin absence. It is mainly seen frequently in type-1 diabetic persons.

Nonketotic hyperosmolar coma: It occurs as a result of excessive glucose accumulation in the body, and affects especially type-1 diabetic elderly persons taking insufficient fluid.

What are Chronic Complications of Diabetes?

ŞLong-term high blood pressure destroys large and small veins, and problems may occur in the destroyed organ.

Cardiovascular diseases: Diabetes is one of the most significant risk factors for cardiovascular diseases. The risk of cardiac insufficiency, heart attack and sudden death has increased 5-fold in diabetic patients. Furthermore, it may cause malnutrition in veins especially in the case of leg vein obstructions.

Eye involvement (retinopathy): The main cause of blindness in adults between 20-74 years of age is diabetes. The cause of this problem is the 25-fold increase in possible blindness in diabetic patients compared to normal persons. A regular and detailed eye examination in diabetic patients is just as important as blood glucose control.

Kidney involvement (nephropathy): Nephropathy is a great threat for diabetic patients. Severe kidney diseases that may necessitate dialysis and/or kidney transplantation can develop in 40% of patients undergoing poor blood glucose control.

Neuron involvement (neuropathy): Neuropathy develops in about 50% of diabetic patients. It causes loss of sense in hands and feet and may lead to vascular obstructions as well as foot wounds and leg amputations. The most frequent cause of hand/foot loss after accidents is unfortunately diabetes. Neuron involvement may also lead to impotence in diabetic patients.

How and Why Should Diabetes Screening Be Conducted?

Especially the common use of presprandial blood glucose is recommended for Type-2 diabetes screening tests, because many persons with diabetes diagnosis criteria are unaware of the disease (ratio of awareness is 50%). Community studies suggest that type-2 diabetes can be present up to 10 years before diagnosis. In almost 50% of type-2 diabetic patients, one or more diabetic complications are present during diagnosis. Early diagnosis and treatment of diabetes can change the course of disease and decrease complications. Therefore, each individual over the age of 45 should be screened every 3 years, and those with additional risk factors in earlier ages.

How Should Diabetes Be Treated?

There is no treatment method to eliminate diabetes. A healthy and active life can be maintained if good support is received from a diabetes team of doctor, dietician and diabetes nurse and advices are followed. The purpose of treatment is to keep blood glucose at near-normal levels and prevent extreme increases and decreases. Diabetes treatment has three components: nutrition treatment, exercise and drug.

Can Diabetes Development Be Prevented?

A good treatment and compliance in diabetes give very good results. The most important strategy after diagnosis of diabetes will be the prevention of diabetes complications. However, what is primarily important is the detection of persons at risk and prevention of diabetes with changes in lifestyle.