Nice information.. Uploaded.. Position statement.. Endocrine society of India Steroids related Hyperglycaemia in covid 19 Management.. Home isolation.. Management in hospitality.. Doses covid 19 patients.. Discharge instructions.. Nice information useful information updated thanks doctor
Informative and educative posts. Endocrine society in india post covid 19 Hyperglycemia by steroid treatment. Common complication but it needs further investigation and evaluation to tackle this complication at the earliest and other post covid 19 complications must needs a detailed and appropriate research and find out the ways to minimize effects and reduces complications .
The significant hyperglycemia that occurs in acute inflammatory state of of covid-19 patients have been found to be pronounced among those with diabetes , prediabetes and opacity. A bilateral link between inflamation and hyperglycemia a complication of diabetes and changes in the immune system including alteration of of cytokines and chemokines and activation state of various leukocytes population,and increased apoptosis and tissue fibrosis Increasing Indulin resistance producing Ian’s stress producing hyperglycemia steroids requirement and use further producing additional hyperglycemia leading to severity of disease
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Apt charting of management and steps to be followed after discharge as it is really important to know and maintain the glucose levels stable. Lifestyle modifications need to be andhered to and monitoring is also required.
+Hyperglycemia induced by glucocorticoids -Daily steroids should be mixed with Sulfonylureas like gliclazide -Multiple Steriod doeses with Insulin shots -Patients should be screened for Diabetes and blood glucose levels -Discharge instructions should involve strict glycemic control and tapering doses of steroids -Educating the patients on Diet, Lifestyle, -Hypoglycemia and steroid withdrawal -Maintaining the glucose log
Insulin - especially Glargine insulin is very important in treatment of Covid 19 I have posted number of cases on Curofy platform suggesting important role of Insulin in prevention of Covid 19, treatment of Covid 19 and treatment of Post Covid syndrome Please read my article published in July 2020 on role of insulin in treatment of Covid 19 https://jmscr.igmpublication.org/home/index.php/archive/178-volume-08-issue-07-july-2020/9517-use-of-insulin-in-treatment-of-covid-19-a-proposal-to-explore-feasibility
Useful & informative post on Steroid- Related Hyperglycemia in COVID-19 & it's Management: Endocrine Society of India's position Statement & highlighted by Medi-Insights.
Inj Lantus to start with 4u Bd also preferable in post covid Hyperglycemia in known Type2DM patients & monitoring the Blood glucose level with appropriate dose of inj Lantus adjustment
VERY USEFUL UPDATE INFORMATIVE AND WELL. DISCUSSED
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FATTY LIVER Nonalcoholic fatty liver disease is an umbrella term for a range of liver conditions affecting people who drink little to no alcohol. As the name implies, the main characteristic of nonalcoholic fatty liver disease is too much fat stored in liver cells. Nonalcoholic steatohepatitis, a potentially serious form of the disease, is marked by liver inflammation, which may progress to scarring and irreversible damage. This damage is similar to the damage caused by heavy alcohol use. At its most severe, nonalcoholic steatohepatitis can progress to cirrhosis and liver failure Nonalcoholic fatty liver disease is increasingly common around the world, especially in Western nations. In the United States, it is the most common form of chronic liver disease, affecting an estimated 80 to 100 million people. Nonalcoholic fatty liver disease occurs in every age group but especially in people in their 40s and 50s who are at high risk of heart disease because of such risk factors as obesity and type 2 diabetes. The condition is also closely linked to metabolic syndrome, which is a cluster of abnormalities including increased abdominal fat, poor ability to use the hormone insulin, high blood pressure and high blood levels of triglycerides, a type of fat. Causes Experts don't know exactly why some people accumulate fat in the liver while others do not. Similarly, there is limited understanding of why some fatty livers develop inflammation that progresses to cirrhosis. Nonalcoholic fatty liver disease and nonalcoholic steatohepatitis are both linked to the following: · Overweight or obesity · Insulin resistance, in which your cells don't take up sugar in response to the hormone insulin · High blood sugar (hyperglycemia), indicating prediabetes or actual type 2 diabetes · High levels of fats, particularly triglycerides, in the blood These combined health problems appear to promote the deposit of fat in the liver. For some people, this excess fat acts as a toxin to liver cells, causing liver inflammation and nonalcoholic steatohepatitis, which may lead to a buildup of scar tissue (fibrosis) in the liver. Symptoms Nonalcoholic fatty liver disease usually causes no signs and symptoms. When it does, they may include: · Enlarged liver · Fatigue · Pain in the upper right abdomen Possible signs and symptoms of nonalcoholic steatohepatitis and cirrhosis (advanced scarring) include: · Abdominal swelling (ascites) · Enlarged blood vessels just beneath the skin's surface · Enlarged breasts in men · Enlarged spleen · Red palms · Yellowing of the skin and eyes (jaundice) Risk factors A wide range of diseases and conditions can increase your risk of nonalcoholic fatty liver disease, including: · High cholesterol · High levels of triglycerides in the blood · Metabolic syndrome · Obesity, particularly when fat is concentrated in the abdomen · Polycystic ovary syndrome · Sleep apnea · Type 2 diabetes · Underactive thyroid (hypothyroidism) · Underactive pituitary gland (hypopituitarism) Nonalcoholic steatohepatitis is more likely in these groups: · Older people · People with diabetes · People with body fat concentrated in the abdomen It is difficult to distinguish nonalcoholic fatty liver disease from nonalcoholic steatohepatitis without further testing. Complications The main complication of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis is cirrhosis, which is late-stage scarring (fibrosis) in the liver. Cirrhosis occurs in response to liver injury, such as the inflammation in nonalcoholic steatohepatitis. As the liver tries to halt inflammation, it produces areas of scarring (fibrosis). With continued inflammation, fibrosis spreads to take up more and more liver tissue. If the process isn't interrupted, cirrhosis can lead to: · Fluid buildup in the abdomen (ascites) · Swelling of veins in your esophagus (esophageal varices), which can rupture and bleed · Confusion, drowsiness and slurred speech (hepatic encephalopathy) · Liver cancer · End-stage liver failure, which means the liver has stopped functioning About 20 percent of people with nonalcoholic steatohepatitis will progress to cirrhosis. HOMOEOPATHIC REMEDIES Homoeopathic remedies are safe remedies for the treatment of fatty liver. Some of the important remedies are given below-- CHELIDONIUM Q- Chelidonium is the top Homeopathic medicine for Fatty Liver treatment. The marked symptom for using this medicine is pain in right upper abdomen and pain under right shoulder. There may also be an enlargement of liver.The person is usually constipated. The stool passes in the form of hard balls. A distended abdomen with nausea and vomiting is also experienced. The patient suffers from excessive weakness. In case of jaundice in a patient with Fatty Liver too, Chelidonium is the best Homeopathic remedy. Desire for very hot drinks and hot food CARDUS MARIANUS Q—.Pain in the liver region . Left lobe is very sensitive. Fullness and soreness with moist skin. Constipation. Stool hard, difficul and knotty. Alternates with diarrhea. Golden colored urine Nausea, vomiting of green acid fluid BOLDO Q- Congestion of liver . Burning weight in liver and stomach. Bitter taste , no appetite LYCOPODIUM CLAVATUM 200- Lycopodium is another remedy of great help for treating Fatty Liver with gastric symptoms and acidity. The patient complains of distension or bloating of abdomen soon after eating anything. The abdomen feels full of gas. Burning belching is also experienced. Even eating a little causes fullness in abdomen. The patient feels heaviness and pain in the right upper part of abdomen. Usually the symptoms get worse towards the evening. Farinaceous food makes the person worse. An unusual craving for sweets and hot drinks in excess may be present. PHOSPHOROUS 200-Phosphorus is the best Homeopathic medicine for patients of Fatty Liver who feel as if the food is coming upwards after eating. This is accompanied by sour belching. Vomiting may also occur in a few cases, along with pain in liver. The stool and flatus are very offensive. The patient feels weak after passing stool. The craving for peculiar things in diet is an important indication for using this medicine in Fatty Liver patients. These peculiar things include ice creams, cold drinks and refreshing items like juices. CALCAREA CARB 30- Calcarea Carb is a very beneficial Homeopathic medicine for mainly obese Fatty Liver patients. The person is fatty, flabby with excess fat in liver and whole abdomen. This Homeopathic remedy successfully helps in burning excess fat in liver.The digestion is very slow in such persons with a long-standing constipation. The abdomen always remains distended. Milk is not suitable for these persons. Desire for boiled eggs or strange things like chalk and pencils. Sensitivity to cold air and excessive sweating on the head. NUX VOMICA 30- Nux Vomica is the best fatty liver remedy in homeopathy when the cause is over consumption of Alcohol . It is prescribed when pain in abdomen begins a few hours after eating, with a feeling of stone in abdomen. Sour or bitter belching accompanies the pain. A very significant symptom for selecting Homeopathic remedy Nux Vomica for Fatty Liver is constipation with an ineffectual urge to pass stool or poop. The stool, however, is insufficient and unsatisfactory. The passing out of stool gives some relief from the pain in abdomen but the urge to pass stool is renewed soon after. The patient craves for fattyfood, spicy food, coffee and alcoholic drinks in diet.Dr. Azher Ansari5 Likes19 Answers
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h/o soft swelling on nape of neck from 1 yr. pain on palpation from 10 days. size 1cm 1 cm Diagnosis ?? t/t ??Dr. Hemant Baonerkar8 Likes26 Answers
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Dear friends and fellow colleagues, Many of our friends on this platform have lot of doubts regarding diagnosis of DM . The following are the criteria for diagnosis of DM except GDM. 1) FPG of 126 mg/dl or more OR 2) An OGTT with 75 g of anhydrous glucose dissolved in water and 2 hr PG of 200 mg/dl or more. OR 3) HbA1c of 6.5% or more OR 4) Casual or Random PG with symptoms of hyperglycemia or hyperglycemic crisis of 200 mg/dl or more. Fasting is defined as no calorie intake for a period of 8 hrs except water as water has no calories. FPG of 100 mg/dl to 125 mg/dl is called IFG Impaired Fasting Glucose. OGTT of 140mg/dl to 199 mg/dl is called IGT Impaired Glucose Tolerance. These two are called Prediabetes. HbA1c The test should be performed in a laboratory using a method that is NGSP certified and standardized to DCCT assay NGSP National Glycohaemoglobin Standardisation Program. DCCT Diabetes Care and Complications Trial. Reference. ADA Standards of Medicall Care in Diabetes published in Diabetes Care an official journal of ADA January 2016 Vol 39, Supplement 1. Thanks a lot my friends, With regards, Dr Sepuri Krishna MohanDr. Sepuri Krishna Mohan26 Likes30 Answers
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Male aged 51yrs old with history of diabetes,6months earlier history of covid 19 infection., now complaining of on and off evening fever and mild cough only when he is at home,on and off complaining of loose motion too or acidity,he has lost around 3 to 4 kgs of weight since 4 to 5 month's. Looks lethargic and had recently diagnosed with high sugar levels but got controlled on medication. B.p: 130/80 Temp: 99.7F Spo2 : 97 %on room air. Complaining of severe weakness with head heaviness, attaching his reports pl help with diagnosis and treatment of case. His today's covid 19antigen is negative.Dr. Chanchal Tiwari6 Likes19 Answers
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DIABETIC NEUROPATHIES. Diabetic neuropathies are a family of nerve disorders caused by diabetes. WHAT CAUSES DIABETIC NEUROPATHY. Nerve damage is likely due to a combination of factors. 1.METABOLIC FACTORS. : hyperglycemia, long duration of diabetes, abnormal blood fat levels and low levels of insulin. 2.NEUROVASCULAR FACTORS : Neurovascular factors leading to damage of blood vessels that carry oxygen and nutrients to nerves. 3.AUTOIMMUNE FACTORS : Causes inflammation of nerves. 4.MECHANICAL FACTORS : Injury to nerves as in carpel tunnel syndrome. 5.INHERITED TRAITS : That increase susceptibility to nerve disease. 6.LIFESTYLE FACTORS : Smoking, alcohol. SYMPTOMS. Symptoms depends on the type of neuropathy and which nerves are affected.Symptoms involve sensory,motor and autonomic nervous system. 1.Tingling, numbness or pain in the toes,feet,legs,hands,arms and fingers. 2.Wasting of muscles of hand or feet. 3.Indigestion, nausea, vomiting, diarrhea,c constipation. 4. Dizziness or fainting due to a drop in blood pressure after standing or sitting up. 5.Problems with urination. 6.Erectile dysfunction. 7.Weakness. TYPES OF NEUROPATHY. Diabetic neuropathy can be classified as 1.Peripheral neuropathy. 2.Autonomic neuropathy. 3.Proximal neuropathy. 4.Focal neuropathy. PERIPHERAL NEUROPATHY. Peripheral neuropathy,also called distal symmetric neuropathy or sensorimotor neuropathy ,is nerve damage in arms and legs.Symptoms are *Numbness or insensitivity to pain or temperature. *A tingling,burning or prickling sensation. *Sharp pains or cramps. *Extreme Sensitivity to touch. *Loss of balance and coordination. Peripheral neuropathy also causes muscle weakness and loss of refle guyxes.Blisters and sites may appear on the numb areas of the foot because pressure or injury goes unnoticed.I f an infection occurs and is not treated promptly,the infection may spread to the bone and the foot may need amputation.Many amputations can be prevented if minor problems are treated in time. AUTONOMIC NEUROPATHY. Autonomic neuropathy affects the nerves that control the heart,blood pressure and blood glucose levels.Autonomic neuropathy also affects internal organs causing problems with digestion,respiration. urination,sexual response and vision. 1.HYPOGLYCEMIA UNAWARENESS. Normally,symptoms such as shakiness,sweating and palpitations occurs when the blood glucose levels drop below <<70 mg/dl.In people with autonomic neuropathy,symptoms may not occur making hypoglycemia to be recognized. 2.HEART & BLOOD VESSELS. Damage to the nerves in the cardiovascular system interferes with the body's ability to adjust blood pressure and heart rate. Due to this,blood pressuremay drop sharply after standing or sitting,causing a person to feel light headed or faint. Damage to nerves that control heart rate makes the heart rate to stay high , instead of rising and falling in response to normal body functions and physical activity. 3.DIGESTIVE SYSTEM. Nerve damage to the digestive system most commonly causes constipation. Damage can also cause the stomach to empty slowly,a condition called GASTROPARESIS. Gastroparesis can lead to persistent nausea and vomiting,bloating and loss of appetite. Gastroparesis also makes blood glucose levels to fluctuate widely ,due to abnormal food digestion. Nerve damage to the OESOPHAGUS MAKES SWALLOWING DIFFICULT. Nerve damage to bowels can cause constipation alternating with uncontrolled diarrhea, 3.URINARY TRACT & SEX ORGANS. Autonomic neuropathy often affects the organs that control urination and sexual functions. Nerve damage can prevent the bladder from emptying completely , allowing the bacteria to grow in bladder and kidneys causing urinary tract infections. When the nerves of the bladder are damaged,urinary incontinence may result because a person may not be able to sense when the bladder is full or control the muscles that release urine. Autonomic neuropathy also leads to decreased sexual response in men and women. A man may have erectile dysfunction or may reach sexual climax without ejaculating normally. A woman may have difficulty in arousal,lubrication or orgasm. 5.SWEAT GLANDS. Nerve damage may cause improper working of sweat glands.It can also result in profuse sweating at night or while eating. 6.EYES. Due to autonomic neuropathy,pupils become less responsive to changes in light.A s a result,a person may not be able to see well when light is turned on In a dark room or have trouble driving at night. PROXIMAL NEUROPATHY. Proximal neuropathy//lumbosacral plexus neuropathy //femoral neuropathy //diabetic amyotrophy causes pain in the thighs,buttocks,hips or legs,usually on one side of the body. FOCAL NEUROPATHY. Focal neuropathy appears suddenly and affects specific nerves,most often in the head,torso or leg. Focal neuropathy is painful and unpredictable.and occurs most often in older adults with diabetes. However,it tends to improve itself over weeks or months and does not cause long term damage. Focal neuropathy can cause *Inability to focus the eye. *Diplopia. *Aching behind the eye. *Bell's palsy. *Severe pain in the lower back and pelvis. *Pain in the front of the thigh. *Pain in the chest and stomach. *Pain on the outside of the shin or inside of the foot. *Chest pain and abdominal pain is mistaken for heart attack or appendicitis. CAN DIABETIC NEUROPATHIES BE PREVENTED. THE BEST WAY TO PREVENT NEUROPATHY IS TO KEEP BLOOD GLUCOSE LEVELS AS CLOSE TO THE NORMAL RANGE AS POSSIBLE.MAINTAINING SAFE BLOOD GLUCOSE LEVELS PROTECTS NERVES THROUGH OUT THE BODY.Dr. Suvarchala Pratap16 Likes27 Answers