Thyroid & Diabetes..

Diabetic patients have a higher prevalence of thyroid disorders compared with the normal population. Because patients with one organ-specific autoimmune disease are at risk of developing other autoimmune disorders, and thyroid disorders are more common in females, it is not surprising that up to 30% of female type 1 diabetic patients have thyroid disease. The rate of postpartum thyroiditis in diabetic patients is three times that in normal women. A number of reports have also indicated a higher than normal prevalence of thyroid disorders in type 2 diabetic patients, with hypothyroidism being the most common disorder.


Thyroid disease in the general
population: 6.6%
Thyroid disease in diabetes:
Overall prevalence: 10.8¬13.4%
Hypothyroidism: 3¬6%
Subclinical hypothyroidism: 5¬13%
Hyperthyroidism: 1¬2%
Postpartum thyroiditis: 11%


The presence of thyroid dysfunction may affect diabetes control. Hyperthyroidism is typically associated with worsening glycemic control and increased insulin requirements. There is underlying increased hepatic gluconeogenesis, rapid gastrointestinal glucose absorption, and probably increased insulin resistance. Indeed, thyrotoxicosis may unmask latent diabetes.

First, in hyperthyroid patients, the diagnosis of glucose intolerance needs to be considered cautiously, since the hyperglycemia may improve with treatment of thyrotoxicosis.

Second, underlying hyperthyroidism should be considered in diabetic patients with unexplained worsening hyperglycemia.

Third, in diabetic patients with hyperthyroidism, physicians need to anticipate possible deterioration in glycemic control and adjust treatment accordingly. Restoration of euthyroidism will lower blood glucose level.

Even subclinical hypothyroidism can exacerbate the coexisting dyslipidemia commonly found in type 2 diabetes and further increase the risk of cardiovascular diseases. Adequate thyroxine replacement will reverse the lipid abnormalities.
In young women with type 1 diabetes, there is a high incidence of autoimmune thyroid disorders. Transient thyroid dysfunction is common in the postpartum period and warrants routine screening with serum thyroid-stimulating hormone (TSH) 6¬8 weeks after delivery. Glucose control may fluctuate during the transient hyperthyroidism followed by hypothyroidism typical of the postpartum thyroiditis. It is important to monitor thyroid function tests in these women since approximately 30% will not recover from the hypothyroid phase and will require thyroxine replacement. Recurrent thyroiditis with subsequent pregnancies is common.

Thanks Dr.deepa

I would like to thank Dr.Deepa (Diabetologist) for her sincere support. Right from the day I started this blog she has spared a bit of her valuble time to go through the posts in my blog and comment about each and every post. I would like to post a small part of her comments which might be useful to the readers of this blog.


Comments about Otelixizumab


This Drug is effective only if there is some beta cell reserve in the body and only if are known to have some autoantibody. Otherwise no use. This has created an excitement in the type 1 children, which actually might not be useful unless they have a significant c peptide level. Pts having a subnormal reserve of insulin can also be tried on this drug as there are other benefits in retaining the existing B-cells.

Comments about Glucometer

Actually the first blood should be wiped off and only the second drop should be taken without squeezing much. Because the first drop contains more of interstitial fluid more than blood. Most of them forget this pt.

Comment about Alcohol & Diabetes

The reason for using calorie free drink mixers is that, by adding soft drinks, the glucose in it can actually trigger insulin release and worsen the anticipated hypoglycemia. Since there is no calorie in alcohol the insulin release cannot be neutralized. The reason why pt develop hypo after taking alcohol is that it suppresses HGO (Hepatic Glucose Output).And most of the pts skip the food after taking alcohol, so the condition is even more worse.

Once again I would like to thank Dr.Deepa for her comments and hope that her support for my blog will continue in future too!!

Can a Diabetic have ALCOHOL??

Beyond all the health and safety concerns about alcohol, if you have diabetes and are on diabetes medications that lower blood glucose, you need to practice caution. Insulin and some diabetes pills can lower blood glucose. So, you should not drink when your blood glucose is low or when your stomach is empty.

Alcohol can cause hypoglycemia shortly after drinking and for 8-12 hours after drinking. So, if you want to drink alcohol, check your blood glucose before you drink and eat either before or while you drink. You should also check your blood glucose before you go to bed to make sure it is at a safe level -- between 100 and 140 mg/dL. If your blood glucose is low, eat something to raise it. The symptoms of too much alcohol and hypoglycemia can be similar -- sleepiness, dizziness, and disorientation.

A Few Guidelines

If you choose to drink alcohol, limit the amount and have it with food. Talk with your health care team about whether alcohol is safe for you.

Women should drink 1 or fewer alcoholic beverages a day (1 alcoholic drink equals a 12 oz beer, 5 oz glass of wine, or 1 ½ oz distilled spirits (vodka, whiskey, gin, etc.)
Men can drink 2 or fewer alcoholic drinks a day.
If you drink alcohol at least several times a week, make sure your doctor knows this before he/she prescribes a diabetes pill.

More Tips to Sip By

Drink only when and if blood glucose is under control.
Do not omit food from your regular meal plan.
Test blood glucose to help you decide if you should drink.
Wear an I.D. that notes you have diabetes.
Sip a drink slowly to make it last.
Have a no calorie beverage by your side to quench your thirst.
Try wine spritzers to decrease the amount of wine in the drink.
Use calorie-free drink mixers -- diet soda, club soda, diet tonic water, or water.
Drink alcohol with a snack or meal. Some good snack ideas are pretzels, popcorn, crackers, fat-free or baked chips, raw vegetables and a low-fat yogurt dip.
Find a registered dietitian to help you fit alcohol into your food plan.
Do not drive or plan to drive for several hours after you drink alcohol.

Landmarks in Insulin's journey!!

1922 Banting, Best, Collip use bovine insulin extract in humans
1923 Eli Lilly produces commercial quantities of much purer bovine insulin than Banting et al. had used
1923 Farbwerke Hoechst, one of the forerunner's of today's Sanofi Aventis, produces commercial quantities of bovine insulin in Germany
1923 Hagedorn founds the Nordisk Insulin laboratorium in Denmark – forerunner of today's Novo Nordisk
1926 Nordisk receives a Danish charter to produce insulin as a non-profit
1936 Canadians D.M. Scott, A.M. Fisher formulate a zinc insulin mixture and license it to Novo
1936 Hagedorn discovers that adding protamine to insulin prolongs the duration of action of insulin
1946 Nordisk formulates Isophane porcine insulin aka Neutral Protamine Hagedorn or NPH insulin
1946 Nordisk crystallizes a protamine and insulin mixture
1950 Nordisk markets NPH insulin
1953 Novo formulates Lente porcine and bovine insulins by adding zinc for longer lasting insulin
1955 Frederick Sanger determines the amino acid sequence of insulin
1969 Dorothy Crowfoot Hodgkin solves the crystal structure of insulin by x-ray crystallography
1973 Purified monocomponent (MC) insulin is introduced
1973 The U.S. officially "standardized" insulin sold for human use in the U.S. to U-100 (100 units per milliliter). Prior to that, insulin was sold in different strengths, including U-80 (80 units per milliliter) and U-40 formulations (40 units per milliliter), so the effort to "standardize" the potency aimed to reduce dosage errors and ease doctors' job of prescribing insulin for patients.
1978 Genentech produces biosynthetic 'human' insulin in Escheria coli bacteria using recombinant DNA techniques, licenses to Eli Lilly
1981 Novo Nordisk chemically and enzymatically converts porcine to 'human' insulin
1982 Genentech synthetic 'human' insulin (above) approved
1983 Eli Lilly and Company produces biosynthetic 'human' insulin with recombinant DNA technology, Humulin
1985 Axel Ullrich sequences a human cell membrane insulin receptor.
1988 Novo Nordisk produces recombinant biosynthetic 'human' insulin
1996 Lilly Humalog "lispro" insulin analogue approved.
2000 Sanofi Aventis Lantus insulin "glargine" analogue approved for clinical use in the US and Europe.
2004 Sanofi Aventis Apidra insulin "glulisine" insulin analogue approved for clinical use in the US.
2005 MedActiv invents the world's smallest fridge, the Medifridge, to safely transport insulin for patients.
2006 Novo Nordisk Levemir "detemir" insulin analogue approved for clinical use in the US.

Colour Coding of Insulin!!