Endocrinology Frequently Asked Questions
In this section are answers to questions about endocrine-related diseases. There are separate sections for diabetes, weight management, pituitary problems and bone problems.
Questions about Diabetes
- What is hemoglobin A1c?
- How do I properly treat a low blood sugar reaction? Should I eat a chocolate bar to bring my sugar back up?
- Why do I have to check my feet every day?
- What foods should I avoid to help control my diabetes?
- What should I check on food labels - sugar or total carbohydrates?
- How much salt or sodium can I have if I am also taking blood pressure medication?
- What is the recommended daily amount of fiber I should eat?
- Can I reuse the lancets and syringes I use for insulin injections?
- What should my blood sugar level be?
- How often should I check blood sugar level?
- How do I care for my eyes?
- If I have gestational diabetes, what should my blood sugar level be?
- What are the symptoms of high blood sugar?
- What are the symptoms of low blood sugar?
Questions about Pituitary Problems
- Do pituitary tumors spread to other parts of the body, like so many other tumors?
- Can pituitary tumors be prevented through diet and exercise?
- How are pituitary tumors treated?
- How do patients who have failure of their pituitary glands live without these hormones?
Questions about Bones
- What is osteoporosis?
- What causes osteoporosis?
- How is osteoporosis prevented?
- Should I be taking calcium pills? There are so many types - which are best?
- What are the signs of osteoporosis?
- Is osteoporosis something only women need to worry about?
- Does everybody get osteoporosis as they get older?
What is hemoglobin A1c?
This is a type of blood test. A hemoglobin A1c percentage is important because it is the only way to know how well patients are controlling their diabetes over time. Based on blood tests taken over a period of two or three months, doctors can estimate patients' average blood sugar levels. The goal for most diabetics is an A1c of less than 7%. This is roughly equivalent to an average blood sugar level of about 150 mg/dl. An A1c of 9% indicates an average blood sugar level of about 210 mg/dl.
Here's how blood sugar works in the body. Glucose (blood sugar) circulates in the blood after food is absorbed in the intestine. A small amount normally combines with the hemoglobin molecule (A1c). Hemoglobin is the red-colored protein in red blood cells that carries oxygen to the rest of the body. It operates in direct proportion to the amount of glucose in the blood. The glucose remains with the hemoglobin molecule until the individual's red blood cells die - usually between two and three months. When the patient's blood is analyzed for hemoglobin A1c, the resulting value number provides an estimate of the level of glucose over that time period.
How do I properly treat a low blood sugar reaction? Should I eat a chocolate bar to bring my sugar back up?
Chocolate is not usually the best choice because the fat in it slows down the absorption of the sugar. Treat a low blood sugar reaction with some type of fast-acting sugar, such as glucose tabs, four ounces of juice, four ounces of nonfat milk or a half can of regular soda.
Why do I have to check my feet every day?
Diabetes often causes poor circulation in the legs and feet. This is one reason people with diabetes must take special care of their feet. Diabetics are likely to have foot problems, such as fungus, ingrown toenails, infections, bunions and ulcers. Most foot amputations can be prevented with good foot care. Note any changes in your feet, such as cuts, scratches, red areas, corns, cracks, itching or other abnormalities. Any changes should be reported to the podiatrist. To smooth down calluses, use a pumice stone when bathing, and never cut calluses off. Trim or file toenails straight across to cut down on the chance of ingrown nails. Make sure shoes fit properly. Pressure from ill-fitting shoes can cause sore areas and lead to ulcers and infections. Patients who have foot pain should see a podiatrist regularly. Most insurance companies will cover podiatry care caused by diabetes.
What foods should I avoid to help control my diabetes?
Foods with higher amounts of simple sugars should be avoided, such as fruit juice, regular soda, sport drinks, candies, sugar, brown sugar, honey, syrup, jelly and jams.
What should I check on food labels sugar or total carbohydrates?
Total carbohydrates include sugar, starches and dietary fiber. The total amount of carbohydrates is what affects blood glucose levels - not just sugar.
How much salt or sodium can I have if I am also taking blood pressure medication?
Patients who take blood pressure medication should limit sodium intake to 2,000 mg a day. One teaspoon of salt contains about 2,300 mg of sodium. Most sodium in the American diet comes from processed or prepared foods, not from the kitchen table salt shaker. Foods that have 400 mg per serving are considered high sodium foods.
What is the recommended daily amount of fiber I should eat?
The recommended amount of fiber is 25 to 30 grams per day. Check for fiber on food labels to help reach this number. Some examples of high fiber foods are fruits, vegetables, legumes and whole grains. Fiber is not completely digested and absorbed in the intestinal system, and it is unavailable as blood sugar. Therefore, a high-fiber meal does not provide as much available carbohydrates as a similar-content low fiber meal. To avoid constipation, increase water intake as more fiber is added to the diet.
Can I reuse the lancets and syringes I use for insulin injections?
We recommend using new lancets and syringes for each injection. However, many people reuse their personal lancets for one week. This is acceptable as long as the lancet device is not shared with anyone else. In reusing the syringe, patients run the risk of insulin contamination. Therefore, every syringe should be discarded after use.
What should my blood sugar level be?
Blood sugar levels change all the time and vary with each individual. The American Diabetes Association recommends the following: after fasting, your blood sugar should be between 80 and 120 mg/dl; before meals, it should be less than 140 mg/dl; and two hours after a meal, it should be less than 180 mg/dl.
How often should I check blood sugar level?
Blood sugar levels should be checked at least twice each day.
How do I care for my eyes?
Visit the ophthalmologist once a year. For patients with retinopathy, an ophthalmologist should be seen on a routine basis.
If I have gestational diabetes, what should my blood sugar level be?
Your blood sugar level should be between 60 and 90 mg/dl when you have been fasting and less than 120 mg/dl two hours after a meal.
What are the symptoms of high blood sugar?
Signs include extreme thirst, frequent urination, dry skin, hunger, blurred vision, drowsiness and nausea.
What are the symptoms of low blood sugar?
Signs include shaking, fast heartbeat, sweating, anxiety, dizziness, hunger, impaired vision, weakness/fatigue, headache and irritability.
Do pituitary tumors spread to other parts of the body, like so many other tumors?
No, pituitary tumors are usually benign. They grow very slowly and do not spread to other parts of the body.
Can pituitary tumors be prevented through diet and exercise?
No, these tumors are caused by an abnormality in the genetic material of the pituitary cell, which causes the cells to continue growing and dividing.
How are pituitary tumors treated?
Some pituitary tumors can be controlled with medication. Others may require surgery of radiotherapy.
How do patients who have failure of their pituitary glands live without these hormones?
We have synthetic hormones that patients take either by mouth or injection to replace the missing hormones from the malfunctioning pituitary gland.
What is osteoporosis?
Osteoporosis is a condition in which bones gradually become thin and lose mass. This causes the bones to become frail and break more easily. Osteoporosis is the most common bone disease in America, affecting about 10 million people.
What causes osteoporosis?
The body is constantly replacing old bone with new bone, just like growing new hair and skin. Osteoporosis occurs when the body does not make enough new bone to replace the old, or old bone is lost too fast for the body to replace it. A number of factors cause bones to begin thinning and become frail. As women become menopausal, they make less estrogen, the female hormone that helps keep bones strong. Other causes of osteoporosis may be a diet low in calcium or vitamin D, heavy steroid use and alcoholism.
How is osteoporosis prevented?
Preventing osteoporosis starts early in life with a good diet rich in calcium and
vitamin D. Frequent exercise also plays an important role since It increases bone strength and makes patients less likely to experience fractures or breaks. After menopause, some women may take estrogen supplements to help keep bones strong. Persons at risk for osteoporosis should be checked regularly by a doctor. When the disorder is discovered early through bone scans and X-rays, the doctor can suggest changes in diet, exercise and medications to keep bones healthy. Unfortunately, when osteoporosis is discovered as a result of a broken or fractured bone, it is too late to take preventive action.
Should I be taking calcium pills? There are so many types - which are best?
Women should take in 1,000 mg of calcium in their daily diet. If there is a strong family history of osteoporosis or osteoporosis has already been diagnosed, a woman should take 1,500 mg of calcium daily. A small daily supplement of vitamin D (400 IU) is recommended because it improves the absorption of calcium by the body. Either calcium carbonate tablets or calcium citrate tablets may be taken four to six times a day up to 1,000 to 1,500 mg total. Calcium citrate is absorbed better by some patients and may have fewer digestive track side effects. Men with osteoporosis are usually given calcium supplements of between 1 and 1.5 grams a day. When there are signs of reduced calcium absorption, supplements can be increased up to three grams a day, and vitamin D supplements of 50,000 IU may be given once or twice a week. However, at dosage levels this high calcium levels should be closely monitored.
What are the signs of osteoporosis?
Some people with osteoporosis experience no symptoms at all, while others may experience pain in the bones and muscles, particularly of the back. A person may experience fractures or broken bones (particularly of the hip and wrist) with very little to cause them. Some people develop humps in their upper back or experience shrinking height because of compression fractures in their backs. When symptoms are experienced, a person may have pain that comes on suddenly, does not radiate, gets worse when weight is put on the area, may be tender locally and generally begins to go away in a week. However, some pain may remain for three months or more.
Is osteoporosis something only women need to worry about?
Both men and women can get osteoporosis. In fact, a rare form of osteoporosis can occur in children and young adults of both genders. Postmenopausal osteoporosis tends to occur between the ages of 51 and 75. Although osteoporosis is six times more common in women, it can also occur in men with low levels of testosterone. Another type of osteoporosis is associated with the normal aging process. It usually occurs in people who are 60 or older, and it is twice as common in women as in men. Osteoporosis can also develop as a side effect of:
- Endocrine diseases, including hyperthyroidism and diabetes mellitus
- Drugs, including glucocorticosteroids, alcohol, tobacco, dilantin, barbiturates and heparin
- Various conditions, including being immobilized, chronic kidney failure, liver disease, chronic obstructive lung disease and conditions in which vitamins and minerals are not absorbed properly
Does everybody get osteoporosis as they get older?
Not everyone gets osteoporosis, but as we age, it is more likely that we will experience some osteoporosis. Besides age and gender, certain things will make osteoporosis more likely, including:
- A family history of osteoporosis
- Being less active
- Not taking in enough calcium, phosphorus and vitamin D
- Having your first period late and menopause early
- Not bearing children
- Drinking coffee or alcohol and smoking
- Being Caucasian or Asian (Blacks and Hispanics have a higher bone mass than do Caucasians or Asians)