Endocrinology Department in Indraprastha Apollo Hospitals Delhi, India

Apollo Centre for Obesity, Diabetes and Endocrinology (ACODE) of Indraprastha Apollo Hospitals offers comprehensive services in diagnosis, treatment and management of all hormonal disorders. Specialized clinics like obesity, bone health & thyroid are designed to provide comprehensive and state-of-the-art management. The department offers a broad range of services for diabetes, thyroid disorders, growth abnormalities in children, infertility in males and females, osteoporosis, pituitary disorders, obesity management, hormone replacement therapy and various other hormonal disorders. An endocrinologist is a specialist doctor dealing with the disorders of the endocrine gland (thyroid, parathyroid, pancreas, ovaries, testis, adrenal, pituitary and hypothalamus). The endocrine system is a complex group of glands which makes the chemicals known as hormones. Hormones also control the way you respond to your surroundings, and they help to provide the proper amount of energy and nutrition your body needs to function. Generally, endocrine diseases have subtle symptoms. In a majority of cases, your doctor will be referring you to an endocrinologist if they think you are having symptoms that need specialist consultation. In general, you will be seeing/referred to an endocrinologist for mainly these diseases:

·         Diabetes

·         Thyroid diseases

·         Metabolic disorders

·         Over or under production of hormones

·         Menopause

·         Osteoporosis

·         Difficult to treat hypertension

·         Lipid disorders

·         Infertility

·         Lack of growth (short stature)

Cancers of the endocrine glands

FAQs on Diabetes and Endocrinology

Q- Foot care in diabetes

Ans- Taking care of your feet is extremely important if you have diabetes as foot & leg

complications are common causes of hospitalization in persons with diabetes & can also lead to

limb amputation if not treated on time. However, most foot problems can be prevented

through proper care & precautions.

You just need to follow these simple steps!!!

Do's

• Notice and feel your feet daily for blisters, open sores, cuts, color changes, or ingrown toe nails.
• Wash your feet daily with soap and lukewarm water.
• Take care to wash between toes.
• Keep your feet  dry especially between toes. Use powder if needed.
• Keep your skin soft. Put lotion on top and bottom of your feet. Do not apply between toes.
• Cut toe nails straight across

Q- What is celiac disease ?

Ans- Celiac Disease is an autoimmune disease which damages the lining of small intestine

and interferes with the absorption of nutrients from the food. People with celiac disease 

cannot tolerate gluten, a protein which is found in wheat, rye, barley and oats. Celiac disease

is genetic, it means has high chance of running in the families. This disease can occur at any age

group from infancy to late adulthood.

Common Symptoms :

• Abdominal Pain, Bloating
• Dental Enamel Defects 
• Diarrhea
• Foul smelling stools which are difficult to flush away
• Growth Failure in children
• Vomiting
• Constipation

How is Celiac Disease Diagnosed ?

On having any of the above symptoms the patient should get in touch with the doctor

for diagnosis of the disease Diagnosis of celiac disease involves a blood test, for levels of 

anti-tissue transglutaminase antibodies (tTGA) or anti-endomysium antibodies (EMA).

A blood test is followed by a biopsy of the small intestine to confirm the diagnosis of the disease.

(Starting on with a Gluten Free Diet before being tested, may result in negative test for 

Celiac disease even if th1 disease is present. Hence one should not start Gluten Free diet before

a confirmed diagnosis is made.)

Treatment :

The only treatment for celiac disease is a strict gluten free diet for life. It's essential that

patients with celiac disease should go for a initial assessment, education and follow up with 

Dietitian and the Doctor for gluten free diet.

Foods Allowed :

Naturally Gluten-free foods include plain meat, poultry, fish, eggs, legumes, nuts, seeds, milk,

 yogurt, cheese fruits, vegetables, as well as many gluten-free flours, cereals and starches that

 can be substituted for wheat, rye and barley. Distilled alcoholic beverages and wines are also

 allowed, however beer derived from barley must b avoided. Patients should consume Gluten 

Free Foods rich in Iron, Calcium, Vit .D and Dietary fiber.

Foods to Avoid :

Patient should totally eliminate wheat and its products, Rye, Barley, Oats from the diet.

Q- Type 1 diabetes mellitus and celiac disease

Ans- Many patients with type 1 Diabetes are also diagnosed with Celiac Disease,

in such cases patients should consult Dietitian who can guide about long term goals and

guidelines for management of both disease. Frequent follow u visits are essential for how

to take Gluten free diet in accordance with diabetic meal plan, monitoring and insulin adjustment.

Use accurate and practical resources on managing both disease. There is a lot of misinformation

about the GF: (Gluten Free Diets) on the internet and from other sources.

FAQs on Endocrinology and Diabetes

Q- Diabetes & exercise

Ans- It's important to keep in mind that if you have diabetes, you always need to be prepared

 before exercising. Always speak with your diabetes care team prior to starting a new fitness routine.

 Keep in mind these points before starting your exercise session :

• If blood glucose levels are less than 90 mg per dl & you are on oral medication- take 3-4 tsp
• sugar before leaving for exercise.
• If blood glucose levels are less than 110 mg per dl & you are on insulin- take 3-4 tsp
• sugar before leaving for exercise.
• If blood glucose levels are more than 300 mg per dl (in case you are on insulin)- don't go for
• exercise until you speak to your healthcare team for further management.
• Make sure you are carrying some sugar or fruit or non diet soft drink or toffee (sugar candy)
• with you while working out because your sugars might just go low in between or after a work- out.
• Bring your glucose meter, since you'll want to check your glucose after every 30 minutes of exercise.

Sick day action plan for managing your diabetes.

Sick day management is important for people with diabetes in order to avoid hospitalization.

When you fall sick your body is under stress, due to which it releases some hormones to get rid 

of this stress condition. These hormones can lead to unexpected changes in the blood glucose levels.

Moreover, during illness, your appetite might vary, along with changes in your exercise or drug routine.

These changes can lead to further complications like Ketoacidosis etc. Thus keeping your blood

sugars under control when sick will prevent a lot of serious complications.

Please read the points mentioned below to manage your diabetes when sick:

Continue your diabetes medicines. Stress of being sick can cause blood sugars to increase unusually.

If you take oral diabetes medication, you will have to continue taking it. In case of stomach

upsets or vomiting or breathing difficulty, you might have to change some medication, for which

you should immediately consult your doctor. You may also need to start with insulin 

for a short period of time depending on your blood sugar control. In case, you are already

on insulin, you need to get your dose revised you're your doctor considering your present

sugar levels, even if you cannot eat your regular food.

FAQs on Endocrinology or Diabetes

Q- Guidelines for insulin

Ans- Insulin hormone is produced by our pancreas in response to our blood sugars. 

Insulin acts like a key, unlocking doors that allow glucose to enter cells. In diabetes,

 either pancreas is unable to produce insulin or the cells are unresponsive to insulin's effect.

Insulin is the safest medicine that your doctor can give you & your body does not get

 used to it. If your body is not producing insulin at all, you will need it for lifetime. Other

 conditions that might need insulin are: Gestational diabetes, diabetes complications where

 in oral diabetic drugs have some side-effects, infections, surgery etc.

How to handle insulin ?

 Insulin is a hormone, which is easily damaged by mishandling & extreme temperatures.

To keep insulin in good condition, remember :

• Avoid excessive physical trauma to insulin such as by vigorous shaking before injecting.
• Avoid excessive heat - like closed cars in warm weather, exposure to direct sunlight
• Avoid excessive cold - like freezer compartment in refrigerator, cargo compartment of air craft.

How to store insulin ?

Unopened vial- can be stored at room temperature for up to 1 month & in the door compartment

 of the refrigerator till the expiry date.

Opened vial- can be stored for 28 days at room temperature & till the date of expiry in the door

 compartment of the refrigerator.

Insulin pen- can be stored in the door compartment of the refrigerator or Air-conditioned room.

 Pen can tolerate up to 30 degree centigrade of temperature.

Insulin cartridges- should be stored in the door compartment of the refrigerator.

While traveling...

While traveling by air, insulin should be kept in the handbag & not in the luggage compartment.

While traveling by train, bus or car, insulin should be kept in a pouch with ice pack or gelpack or

 dry ice....

Modes of insulin injection :

• Syringe
• Insulin pen
• Insulin pump

FAQs on Diabetes or Endocrinology

Q- Type 1 diabetes information for parents.

Ans- If you're like most parents who have just been told your child or teen has type 1 diabetes,

 it is a complete shock. Only about 10 percent of the time do we find a family history of type 1 

diabetes. There is more to learn about what causes, prevents and cures type 1 diabetes.

In the meantime, we must all work together to help your child live a long and healthy life.

And yes, that is a realistic goal. Research studies show that people with type 1 diabetes

 who aim to keep their blood glucose levels as close to normal as possible can significantly

 lower the chances of life-threatening complications related to diabetes.

What goes wrong ?

The diagnosis of type 1 diabetes was made because your child's level of glucose (sugar)

 in the blood was above normal. This indicates that the metabolic system of checks and

 balances in the body is not working. Insulin is not being produced. Insulin is essential to

 escort the glucose from the foods we eat into cells of the body where it is critically needed

 to function properly. As a result, glucose builds up in the bloodstream.

Your child may still be producing some insulin at this point, but in type 1 diabetes the 

pancreas loses all ability to produce insulin. The islet cells in the pancreas that produce

 insulin are gradually all destroyed, a process that we cannot at this point stop. Injections of insulin

 or an insulin

 pump are then needed to survive.

Why not an insulin pill ?

Insulin can't be given orally because it is a protein and would be digested instead of getting to

 the blood stream where it is needed. Just about all of the commercially available insulin

 now are genetically engineered as human insulin. Insulin comes in a variety of preparations that

 differ according to how fast it takes effect, when that effect is the greatest, and how long it

 continues to work in the body.

Living with diabetes.

What seems overwhelming now will eventually become routine. One of the first hurdles to 

get over is that to help your child, you must prick him or her with a needle. This will get easier for

 all involved. There are new devices as well as some in development that make blood 

glucose testing and insulin injections less painful, easier and more precise.

To live successfully with diabetes essentially means to learn how to be a pancreas.

 You have to learn how to monitor blood glucose levels and adjust the levels of insulin

 needed accordingly. To do this,you must consider several factors :

• Blood glucose levels, measured several times a day.
• The timing and content of meals eaten (specifically, considering type and amount of 
• carbohydrates in the foods).
• The amount of physical activity, which requires more glucose and thus more insulin.
• And then based on need, getting doses of insulin through multiple injections or an insulin 
• pump into the body multiple times a day.

FAQs on Endocrinology or Diabetes

Q- What you should do.

Ans-Each day :

• Check your blood glucose - ask your healthcare provider how often and the best times of
• day to check.
• Examine your feet and toenails for any wounds.
• Be physically active each day.
• Take aspirin if your doctor has suggested it.

2-4 times each year :

• Have your HbA1c checked by your doctor or healthcare provider.

At least once a year :

• Visit your doctor to discuss goals for the care of your diabetes.
• Visit your dentist for a regular check-up.
• Get a flu shot to prevent complications from illness.
• Have your doctor check your blood pressure and discuss the results with you.
• Have a dilated eye exam.

Q- Gestational diabetes

Ans- Gestational diabetes (GDM)  is a form of diabetes that occurs during pregnancy.

Gestational diabetes usually is detected between the 24th and 28th week of pregnancy.

It may be comforting for you to know that the condition can be easily managed.

You should speak to your doctor regarding your medical, nutritional & fitness goals that

will help you take control of gestational diabetes and decrease the risk of complications.

Diagnosis: Shortly after your pregnancy is confirmed,your doctor will arrange for you to

have an Oral Glucose tolerance test (OGTT) if you are at risk of having diabetes.You may be

at risk of having GDM if:you have a previous history of GDM, have had a large baby,

there is a persistence of glucose in your urine,have a familY history of diabetes or you are

 overweight.

The OGTT is usually performed at approximately 28 weeks of 

In case your sugars are not under controlconsistently:

• The baby can be larger in size which can lead to complications during delivery.
• Pre mature delivery or still birth or birth hypoxia.
• Post delivery, baby can have low sugars that need immediate attention or else it can be life
•  threatening.
• Mother may suffer from pre-eclampsia.

Q- Know your insulin pump.

Ans- Insulin pumps are small, portable devices used to deliver insulin under the skin 

via a canula. Insulin pumps are usually placed in pouches, pockets, belts and their

 features vary considerably. All contain a disposable cartridge inside the unit and deliver

 insulin in two ways: "basal" or background insulin that is delivered every few minutes

 and "bolus" insulin that is delivered when meals are eaten or to correct high blood sugars.

A canula is inserted under the skin and worn at all times when an insulin pump is in use.

 The canula is changed every 2-3 days or if the site goes "bad" and no longer properly works

 for insulin doses. Canulas may be worn anywhere where insulin can be injected such as 

on the stomach, thighs, buttocks and fleshy areas of the arm.

Advantages of insulin pump :

• It delivers better blood sugar control as it can imitate your pancreas the closest out
•  of all the
•  insulin modes.
• With insulin pump your frequency of pricking also limits majorly (once in 3 days).
• You get more flexibility to eat yourfavorite food items occasionally as your pump has a lot of
•  other wizard features to assist you in better bloodglucose control.
• A decreased risk of dangerously low sugars.
• No unpredictable effects from long or intermediate acting insulin as it uses only rapid
•  acting insulin.
• It has the ability to accurately dose even the tiny amount of insulin.
• It is a precise consistent way to deliver a basal rate of insulin.
• It has the ability to program variable insulin rates throughout the day based on your
•  sugar readings