LET'S TALK ABOUT HORMONES

Hormones are chemicals which circulate in the blood stream and spread around the body to carry messages or signals to different parts of the body. The name hormone comes from the Greek word hormao meaning “to excite”, referring to the way each hormone excites or stimulates a particular part of the body. There is more than 200 hormone or hormone-like substances in the human body.  Some are produced by glands and some are produced or managed by other organs with endocrine tissue.

 

 

There are 6 major glands in the body:

1. Hypothalamus – Situated in the brain and it’s attached to the Pituitary via a stalk-like structure.  It acts as a collecting centre for information concerned with the internal well-being of the body.

2. Pituitary – It’s about the size of a pea and it’s located beneath the brain, just behind the bridge of your nose.  It is often referred to as the “master gland” because it controls the functions of other glands.

3. Thyroid – Located in the front part of the neck, near the windpipe.  It controls many bodily functions such as heart rate, temperature and metabolism.

4. Parathyroid – These are 4 tiny glands located behind the thyroid.  They process the calcium in your body.

5. Adrenals – As the name suggests, these glands are located just above the kidneys.  They produce hormones essential for life and to help us cope with stress.

6. Pineal – It’s a tiny gland located at the base of the brain and produces the hormone melatonin, helping to control your sleep and wake cycles.

 

There are other organs in the body containing endocrine tissue:

1. Kidneys – They control the blood fluid and mineral levels in the body by processing the blood to remove waste and any excess fluid.

2. Ovaries – Besides housing the egg cells needed for reproduction, the ovaries also produce the hormones Estrogen and Progesterone, necessary for menstruation and female sexual characteristics.

3. Testes – They produce the necessary hormones responsible for the production of sperm and other male sexual characteristics.

4. Pancreas – Cells in the pancreas produce insulin and glucagon, hormones which regulate the blood sugar that provides the body with energy.

DIABETES

Diabetes affects about 12% of the population in the United States.  To understand diabetes, we must understand insulin.  It is a hormone produced by your pancreas and helps move sugar, or glucose, in your body’s tissues.  Cells use glucose as fuel. When the beta cells in your pancreas either do not produce insulin or can’t produce enough insulin or the body can’t use the insulin well enough, people develop diabetes.

 

There are two main types of diabetes:

 

Type 1 – it happens when your pancreas can’t produce any insulin.  This type of diabetes is less common.  Only about 5% of people with diabetes have Type 1.

 

Type 2 – it happens when beta cells in your pancreas are still able to produce insulin, but maybe not in enough quantities.  This is the most common type of diabetes, affecting 90-95% of the 26 million of Americans with diabetes.

 

There is also pre-diabetes, a precursor of Type 2 Diabetes.  It is sneaky and has no symptoms.  If people were diagnosed more often and made changes to their current lifestyle – by changing their diets, exercising and maintaining a healthy weight, possibly it could prevent more serious problems later on.

 

There is also gestational diabetes, and it only occurs during pregnancy.  If you develop it, you can still have a healthy baby if your glucose is well controlled. And after the baby is born, you may not have diabetes anymore.  However, if your placenta makes hormones that can lead to a buildup of sugar in your blood and your pancreas can’t make enough insulin to handle it, you should get the advice of an endocrinologist.  A specialist will help you learn how to manage this condition best.

 

Anybody can develop diabetes.  Type 1 diabetes usually starts in people under age 20.  Type 2 Diabetes is more prevalent in people aged 45+, but unfortunately, with the poor lifestyle choices nowadays, Type 2 diabetes is diagnosed in younger and younger people, even kids.

 

Some of the risk factors for Type 2 Diabetes are:

• Being overweight or obese

• Have a family history of Type 2 diabetes

• Don’t exercise

• Have low HDL cholesterol

• Have high triglycerides

• Have high blood pressure

• African Americans, Latinos, Native Americans and Asian Americans are particularly more at risk

 

The only way to tell if you have diabetes is to get tested.  Diabetes sometimes develops without symptoms, although many people experience these, regardless of the type of diabetes:

 

• Heavy thirst

• Dry mouth

• Frequent urination

• Fatigue, weak and tired feeling

• Blurred vision

• Increased hunger, especially after eating

• Frequent infections of the skin, urinary tract and vagina

 

There’s no need to be afraid of diabetes.  It is indeed a serious chronic condition, but many people with diabetes live long, healthy lives.  The key to good health is to keep your blood sugar levels within the range your doctor gives you.  You will need to check it often and adjust insulin, food, medications and/or activities to make that happen.

 

Knowledge is power and you are the most important person in your diabetes care team.  Your endocrinologist will depend on you to talk to her honestly and supply information about your body.  Besides an endocrinologist, you might need to have some other health professionals on your care team, such as a dietitian, eye doctor, podiatrist, dentist and even an exercise trainer. The implications of not taking care of your diabetes properly can be serious and even life-threatening.  Many people don’t realize that when blood sugar isn’t under control it can lead to complications such as blindness, amputation, heart disease and stroke.

 

Diabetes is manageable.  Work closely with your endocrinologist to create a diabetes management plan including diet, exercise and medication to help you reach your blood sugar goals.

DIABETES in PREGNANCY

Most women with diabetes can have a safe pregnancy and delivery if they have tight blood sugar control before becoming pregnant. If you have type 1 or type 2 diabetes, it is important to get good health care before and throughout your pregnancy. If you have diabetes and want to have a baby, get a check up before becoming pregnant.  Ideally your partner should join you and you should see a team of healthcare providers that includes your endocrinologist, a diabetes educator, a dietitian and an obstetrician. At these visits, the healthcare team will counsel you on the following areas:

 

Blood glucose – While pregnant, you will probably need to check your blood sugar more often than before pregnancy.  Check your blood sugar as often as your doctor recommends.

Insulin – You may require insulin during your pregnancy, even if you have Type 2 diabetes.  Sometimes, using an insulin pump may be appropriate. If you were already using an insulin pump before pregnancy, you should keep using it.

Nutrition – A healthy eating plan, tailored to your needs, helps make sure you get the nutrients you and your baby need, gain the right amount of weight, while controlling your blood sugar.

Vitamins –Ask your doctor about which prenatal vitamins you need, including folic acid, which helps lower the risk of having a baby with birth defects of the brain and spinal cord.

 

You should also learn what you should do before pregnancy to have the best chance for a healthy baby.  Experts recommend:

Get an eye exam – See an eye doctor to find out if you have diabetic eye disease or retinopathy.

Control your blood pressure – Your blood pressure should be normal or close to it. High blood pressure can affect you and your unborn baby.  Pregnant women with high blood sugar are more likely to have a baby with birth defects, have a miscarriage, give birth too early, need a C-section or have a difficult delivery.

Lose weight, if you’re overweight before becoming pregnant.

Ask your doctor if you should stop taking any of your medicine or change to a different medicine - Certain medications may not be safe for an unborn baby.

 

You can help ensure your baby’s health and your own health.  Work with your endocrinologist and your obstetrician to get proper medical care before, during and after pregnancy. With careful planning, proper medical care and good self-care, you can have a safe pregnancy and a healthy baby.

 

Some women develop a temporary diabetes during their pregnancy, called gestational diabetes.  Women with gestational diabetes also need special care during their pregnancy.  Visit an endocrinologist to learn how to best manage this condition.

 

THYROID

The thyroid gland is a small, butterfly-shaped gland in the front of your neck.  Its hormones travel from the thyroid gland through the blood to all parts of the body. Thyroid hormones help all your organs to work well and control how your body uses food for energy.  These hormones affect your metabolism rate, which means how slow or fast your brain, heart, muscles, liver and other parts of your body works. If your body works too fast or too slow, you don’t feel well.

 

When the thyroid gland doesn’t make enough thyroid hormone, it’s called hypothyroidism.  That’s when some parts of the body work too slowly.  When this happens, you feel tired, feel cold even when other people are comfortable or even warm, have a slow heart rate and dry skin, become constipated, and gain weight even though you’re not eating more or exercising less than usual.

 

When the thyroid gland makes too much thyroid hormone it’s called hyperthyroidism.  When this happens, people feel nervous and irritable, they have trouble concentrating, they feel too warm even when other people don’t feel warm, produces fast heart rate and diarrhea, make people have trouble sleeping and they lose weight without trying.

 

The thyroid can also develop a lump or swelling, called a nodule.  It may also become enlarged, known as a goiter.  Most nodules are benign, but some can be cancerous.  Cancer of the thyroid is quite rare and occurs in about 5% of thyroid nodules.

 

Anyone, even babies can have problems with their thyroid.  And the effect of any of these conditions could be unpleasant or uncomfortable, but most thyroid problems can be managed well if properly diagnosed and treated.

 

Visit an endocrinologist to get an accurate diagnosis and a treatment plan that will make you feel better.

 

OSTEOPOROSIS

Bone is living tissue that is constantly being broken down and repaired.  Osteoporosis occurs when the creation of new bone doesn’t keep up with the removal of old bone.

 

Osteoporosis causes bones to become weak and brittle – so brittle that a fall or even a mild stress like bending over or coughing could cause a fracture.  These fractures are most common in the hip, wrist or spine. Osteoporosis affects men and women of all races, but White and Asian women, especially who are past menopause, as at the highest risk. There are no symptoms in the early stages of bone loss, but after osteoporosis is present you may have symptoms like back pain caused by a fractured vertebrae, loss of height, stooped posture or a bone fracture that occurs much more easily than expected.

 

Most people reach their peak bone mass by their early 20’s.  As people age, bone mass is lost faster than it is created.  How likely you are to develop osteoporosis depends partly on how much bone mass you attained in your youth.  The higher your “peak bone mass”, the less likely you are to develop osteoporosis as you age.

 

Some risk factors for osteoporosis are out of your control:  Your gender, age, race, family history and body frame size.  Women and the older you get make people more at risk.  If any family member has had osteoporosis and you have smaller frame puts people at a higher risk because they possibly have less bone mass to draw from.

 

There are other risk factors related to your hormone levels, diet, medications or lifestyle choices:

 

Lowered sex hormones, too much thyroid hormone or overactive adrenal glands tend to weaken bone.

Low calcium intake, suffering from anorexia or having gone through a reduction in your stomach or other types of gastrointestinal surgeries sometimes affects the body’s ability to absorb nutrients, including calcium.

Long-term use of oral or injected corticosteroid medications, such as prednisone or cortisone, interfere with the bone-rebuilding process.

A sedentary lifestyle, not exercising enough, excessive alcohol consumption and tobacco use contribute to weak bones.

 

Even though older women are more at risk to develop osteoporosis, about 20% of the Americans diagnosed with osteoporosis or osteopenia are men.   Men are 2 to 3 times more likely than women to die after breaking a hip.  So guys…  you need to take osteoporosis seriously.

 

You may want to talk to your endocrinologist about osteoporosis if you went through early menopause, took corticosteroids for several months at a time or if either of your parents had hip fractures.

LOW TESTOSTERONE

Testosterone is a hormone. It’s what puts hair on a man’s chest and the force behind his sex drive.    In summary, it’s what makes a man a man…

During puberty, testosterone helps build a man’s muscles, deepens his voice and boosts the size of his penis and testes.  In adulthood, it keeps a man’s muscles and bones strong and maintains his interest in sex. Testosterone is responsible for the normal growth and development of the prostate,  but also controls a man’s mood and energy level, bone strength and changes in muscle mass and fat distribution.

 

Hypogonadism is a condition commonly known also as “male menopause”, referring when males experience a decrease in either testosterone production, sperm production or both. Male testosterone levels decrease gradually over time naturally, but when  it decreases more than it should, men can experience a range of symptoms:

 

Low sex drive – Testosterone plays a key role in a man’s libido and it could also make it difficult to achieve and erection and orgasm.

Low semen volume – The more testosterone a man has, the more semen he produces.  Men with low levels of testosterone will notice a decrease in the volume of sperm during ejaculation.

Hair loss – Testosterone plays a role in hair production and low levels will reflect as a loss of facial and body hair.

Fatigue and lack of energy

Loss of muscle mass and bone mass – Even with weight training, it may be difficult to build or rebuild muscle.  Also, bones become more brittle, fragile and more prone to fractures.

Mood changes – Testosterone boosts mood and mental capacity in men.  Low levels of testosterone produce depression, irritability or a lack of focus.

 

 

 

It is important to assess if a low testosterone level is simply due to the decline of normal aging, other health conditions or if it’s due to hypogonadism.

 

Testosterone replacement therapy is a fairly common treatment and can provide the patient with many benefits.  Some people even make it sound like the ultimate masculine anti-aging formula. Patients undergoing testosterone replacement therapy experience an increase in energy levels, decreased irritability and depression, higher motivation, improved muscle mass, decreased body fat and improved sexual desire. But there are also risks that you and your endocrinologist should assess as a team. For example, testosterone replacement therapy is not recommended in men with an enlarged prostate and it could also lead to an increase of red blood cells that increases the chances of blood clots, heart attack or stroke, among others.

 

Please note that some of the symptoms and signs of low testosterone levels are a normal part of aging.  Others can be caused by various underlying factors, including medication side effects, thyroid problems, depression and excessive alcohol use.  An endocrinologist can accurately diagnose hypogonadism or the potential cause of the symptoms you might be experiencing.

 

PITUITARY

The pituitary gland is a tiny organ, about the size of a pea located at the base of the brain, just behind the bridge of your nose.  It is often referred to as the “master gland” because it controls the functions of other glands. This small gland is responsible for making and storing many different hormones. Even though it’s small, the front part of the pituitary is responsible for certain hormones and the back part  is responsible for others.

 

The following hormones are made in the front part of the pituitary:

Prolactin  - Stimulates breast milk production after childbirth.

Growth hormone – GH stimulates growth during childhood but it’s also important in adults by maintaining muscle mass, bone mass and fat distribution in the body.

Adrenocorticotropin  - ACTH helps maintain blood pressure and blood sugar levels.  It is produced in larger amounts when we’re under stress.

Thyroid-Stimulating hormone – TSH stimulates the thyroid gland to produce its hormones to regulate the body’s metabolism, energy balance, growth and nervous system activity.

Luteinizing hormone – LH stimulates testosterone production in men and ovulation in women.

Follicle-stimulating hormone – FSH promotes sperm production in men and stimulates the ovaries to produce estrogen and develop eggs in women.

 

The following hormones are stored in the back part of the pituitary gland:

Antidiuretic hormone – ADH regulates water balance in the body.  It conserves body water by reducing the amount of water lost in urine.

Oxytocin – This hormone causes milk to flow from the breasts in breastfeeding women and may also help labor to progress.  Lately, it’s been widely dubbed “the love hormone” since researchers have begun to uncover its effects on behavior, including its role in love.

 

The most frequent type of pituitary disorder is a benign growth, known as tumor or adenoma.  These tumors are fairly common in adults.  They are not considered a brain tumor and most are not cancerous. These growths in the pituitary can be secretory, that produce too much of a hormone normally made by the pituitary.  Non-secretory growths do not produce much of any pituitary-produced hormone.

 

Please visit an endocrinologist for a more accurate assessment of your symptoms or condition.

 

PCOS

Polycystic ovary syndrome is a common hormonal disorder among girls and women, during their reproductive years.  Women with PCOS produce more amounts of male hormones, such as testosterone, than women without the condition.

 

The characteristics of PCOS might be experiencing irregular menstrual periods, having too much hair on the body and face and having very large number of follicles on the ovaries.  These many follicles look like cysts, where the term “polycystic” came from. PCOS seems to be present in obese women and girls and whose family members also have it.  Many women with PCOS also have too much insulin in their bodies because the insulin does not work as well as it should.

 

Some of the signs and symptoms of PCOS are:

• Irregular menstrual periods

• Periods that are very heavy or very light

• Infertility or trouble getting pregnant

• Excess or unwanted hair growth on your face, chest, back, hands, upper arms and legs, or around your nipple.

• Thinning hair on you scalp

• Weight gain or obesity, often around your waist

• Acne on your chest, back and face

• Skin tags on your neck and armpits

• Poor sleep

• Depression or anxiety

 

Teens and women with PCOS are also at a higher risk for type 2 diabetes, high blood pressure and high cholesterol. There is no single test to detect or diagnose PCOS.  Sometimes blood tests are needed to measure your hormone levels.  Before doctors diagnose PCOS, they must first rule out or exclude other conditions with similar symptoms, calling it on occasion “a diagnosis of exclusion”.

 

It’s important to visit an endocrinologist, an expert in the hormones in your body, to help make a correct diagnosis and provide you with the specific care you need. There is no “cure” for PCOS, but treatment and lifestyle changes can help with symptoms and put your hormones back in balance.

 

TRANSITION TO AN ADULT ENDOCRINOLOGIST

If you or your child were diagnosed with Type 1 Diabetes when he or she was young, at some point you’ll reach the point when a transition from a pediatric endocrinologist to an adult endocrinologist needs to happen.

 

Type 1 Diabetes is a chronic, life-long condition and young adults, and their families as a whole, need to learn how to live with it.  When patients are diagnosed at an early age, parents usually are mostly responsible for the diabetes day-to-day care of their child.  But as children grow into young adults with Type 1 Diabetes, they need to create healthy, structured diabetes behaviors – committing to self-monitoring, paying attention to their meals, exercising, among others – so they are more likely to stick with these behaviors for years to come.

 

Young adults usually start handling their diabetes on their own anywhere between the ages of 18-25.  In most cases, when the teenager is leaving for college or moving out of his parent’s home.   But doing it early is best…  you don’t want to be coming up the end of summer before you’re leaving for college for the first time and realize you’re not prepared for this next step in your life.

 

Starting early, parents can encourage their kids to ask questions during doctor’s appointments.  This will help them understand that one day, they will not be there to ask questions for them and interpret information.  If a child learns early to take an active role in his/her care it won’t be as intimidating later on.

 

But the most daunting step in the transition will definitely feel the moment when you will need to switch providers.  You probably have been working with your pediatric endocrinologist for years now and have formed a bond with your team.   You need to prepare for this next step… it’s challenging and there are no set of rules to make it easier.

 

Something that can help ease the transition is that Dr. Rodríguez was a pediatric Type 1 Diabetes patient once.  She was diagnosed with it when she was 15 years old.  She knows first-hand what it is to be diagnosed at an early age, to transition to an adult endocrinologist team, to start managing her diabetes on her own and eventually going to med school to become an endocrinologist herself.  She understands the importance of making a smooth transition – one that will instill confidence on both the young adult patient and his/her parents.

 

Why is it important to transition to an adult endocrinologist sooner rather than later?

 

If the transition from a parent handling the day-to-day management of his child’s diabetes to them self-managing isn’t handled well, it can have long-term consequences. If the glucose levels of a young adult diabetes patient are not within the recommended range for a long time, early signs of diabetes complications, such as heart disease or eye trouble, can start to show up in their mid-20’s.  Maintaining good control is especially vital…

 

Our intention is not to scare you, but research tells us the competing distractions of young adult life often interfere with the requirements of successful diabetes management.  The challenges of school and/or work often take precedence over diabetes care.  Young patients are at a high risk for disengaging from health care and give way for complications that may go undetected without appropriate follow-up care and screening.   Glycemic and diabetes control is poorer when patients do not understand and participate in their care.

 

The risk lies that pediatric care for diabetes tend to be family-focused, holistic and centered on management approaches that fit diabetes into the child and family’s lifestyle.  In adult care, the focus is more on the individual patient, who can be informed or counseled but then, is expected to make his/her own choices about behavior or treatments.   Adult endocrinologists follow guidelines that are specifically designed to address the complications of diabetes, something a pediatric physician handles quite infrequently.   Continuous diabetes care and follow-ups helps reduce the need for costly hospitalizations, and provides early intervention of chronic complications to optimize long-term health.

 

Whenever you’re ready for more independence with monitoring your diabetes and to transition to an adult endocrinologist, Dr. Rodríguez and the diabetes community is here to help you.  You do not have to do it alone.  We have your back…

 

Talk to your pediatric endocrinologist about your interest in starting the transition process and set up an appointment to understand our philosophy on diabetes care and management.  Consider it like an interview for you to understand if our approach aligns with yours.

 

We are here to encourage and help you pass the baton to your young adult and allowing him or her to take responsibility for his/her health for years and years to come.

 

What will I have to do differently once I transfer to adult diabetes care?

 

If you’re a teen or young adult who was diagnosed with Type 1 Diabetes, there will come a time when you will need to start taking responsibility for managing your diabetes on your own – without the help of your parents.

 

With your growing independence, you will need to start understanding how to check your blood sugar levels, what to eat, when to take special care of yourself, among other responsibilities proper of becoming a young adult.  A great time to start this is during your junior or senior year in high school.  By this time, you’re much more independent and can start taking on some of the responsibilities your parents once took care for you when you were younger.

 

It’s important you start a relationship with an adult endocrinologist early on to help you gather the necessary tools to prevent and avoid the complications of diabetes mis-management.  Diabetes is a chronic, life-long condition that you need to learn to live with…

 

You need to come to terms with living with diabetes and effective care entails having clear and concrete goals for diabetes care.  Young adults sometimes feel discouraged and overwhelmed with their diabetes regimen, sometimes they feel guilty when they get off-track with their care or worry about the future and the possibility of serious complications.  Relax… no need to stress about this.  With the right approach and information, you can live a long, productive and happy healthy life with Type 1 Diabetes.

 

Here we share a list of things you should be able to do or discuss with your doctor on your own to be successful at managing your Diabetes:

 

• Make doctor’s appointment and attend appointments on your own

• Provide your own medical history

• Adjust insulin levels for carb intake and blood glucose levels

• Track daily glucose levels

• Understand how exercise or alcohol consumption affect blood sugar levels

• Understand the symptoms of low blood glucose levels and how it affects your ability to drive and perform other activities

• Order insulin, test strips, and ketone strips.

• Understand the long-term complications of type 1 diabetes

 

The more knowledge you have about diabetes, the more prepared and empowered you will feel to be an engaged and healthy patient.  Building up your confidence little by little in your high school years will prove beneficial when you go away to college and transition responsibly to adult diabetes care.

 

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