Endocrine system problems in GP

09/13/15 Prof.Dr.R.R.Deshpande 109/13/15 Prof.Dr.R.R.Deshpande 1
Endocrine Problems in GP
• Presented By –
• Prof.Dr.R.R.Deshpande (M.D in Ayurvdic
Medicine & M.D. in Ayurvedic Physiology)
• www.ayurvedicfriend.com
• Mobile – 922 68 10 630
• mailme.drrrdeshpande@rediffmail.com

Endocrine glands
09/13/15 2Prof.Dr.R.R.Deshpande

Endocrine Problems
• 1) Diabetes Mellitus
• 2) Hyperthyroidism
• 3) Hypothyroidism or Myxopedema
09/13/15 Prof.Dr.R.R.Deshpande 3

Causes of Diabetes Mellitus

Diabetes Mellitus –
Clinical Features
• 1) Monilial Balanitis : In elderly male.
• Itching of Genital (candidiasis) – elderly
females
• 2) Peripheral Neuritis – Tingling and
numbness of the extremities or pain in
both the legs
• 3) Non healing wounds

Monilial Balanitis – in DM

Non healing wound – in DM

Repeated Furunculosis –in DM

Diabetes Mellitus –
Clinical Features
• 4) Recurrent furunculosis
• 5) Tiredness, weakness and loss of weight
in spite of good appetite.
• 6) Nocturia
• 3) Poly :
• 1) Polyuria 2) Polydypsia 3) Polyphagia

Symptoms of DM

Diabetes Mellitus - Lab
• 1) 8 hrs. fasting Blood sugar > 126
mg/100 ml
• 2) 2 hr. post glucose (75 mg) > 200
mg/100 ml
• 3) symptoms of D.M. + Random Blood
sugar > 200 mg / 100 ml

Diabetes Mellitus - Lab
• 1) Impaired fasting blood sugar (IFG) –
100 -125 ml/100 ml
• 2) Impaired glucose Tolerance (IGT) –
141 – 199 mg/100 ml.
• If IFG & IGT – Risk of developing D.M. or
cardiovascular problems

Types of Diabetes Mellitus
• 1) Type I – Juvenile onset – Insulin
depend DM --- IDDM
• Auto antibodies destroy β cells, hence
insulin deficiency.
• 2) Type II – Maturity onset DM = NIDDM
• Occurs mostly in above 40 years
• reduced insulin secretion or peripheral
resistance to action of insulin.

Types of Diabetes Mellitus
• 3) Gestational DM :
• Develops in pregnancy and disappears
after delivery, but increase risk of getting
DM in later life.

Features of Type I DM :
• 1) Commonly develops in children and
young adults
• 2) Acute or sub acute onset
• 3) Tendency to keto acidosis
• 4) Life long insulin dependant

Features of Type II DM
• 1) Very common seen in 95 % of total
diabetic patients.
• 2) 80 % are over weight
• 3) Insidious onset
• 4) seen after the age of 30-40 years
• 5) Can be managed by diet, exercise,
OHA (Oral hypoglycemic agents)
• Insulin may or may not be required.

Complications of DM :
• 1) Infections like cellulitis, pulmonary T.B.
• 2) Short term metabolic complications.
• a) Diabetic ketoacidosis
• b) Hypoglycemic coma

Complications of DM

Complications of Obesity

DD of Hyper & Hypoglycemia
Hyperglycemia Hypoglycemia
1) History Heavy carbohydrate meal but
no insulin and infection
Missing meals, starvation,
heavy exercise and
overdose of insulin
2) Onset Slow Rapid
3) Clinical
features
Excess thirst, polyurea,
abdominal pain, vomiting
Severe acute weakness,
profuse sweating, tremors,
palpitation.
4) O/E Signs of dehydration present.
(dry skin and tongue, plantar
reflex is flexor i.e. normal)
Skin and tongue moist,
plantar is extensor

DD of Hyper & Hypoglycemia
Hyperglycemia Hypoglycemia
5) Smell of acetone Present diabeto ketoacidosis Absent
6) Sugar level High (upto 1000 mg/100 ml by
glucometer)
Low glucose level (below 50
mg)
7) Sugar Sugar and ketone bodies +++ Absent
8) prognosis Bad (due to complications) (eye,
kidney, heart & brain affects)
Good (if treated promptly)
9) Therapeutic tests
or treatment
25 % I/V glucose. No response
for unconscious level.
250 I/V glucose. Patient
instantly wake from drowsy /
unconscious state

• 3) Long term Angio-pathic
• a) Retinopathy
• b) Nephropathy
• c) Neuropathy

• 4) Macrovascular (large vessels)
• a) Coronary artery disease
• b) Cererbo vascular disease
• c) Peripheral vascular disease

Prevention of complications :
• 1) Lifestyle modification
• 2) Strict control on blood sugar
• 3) Excellent control on B.P.
• 4) drugs like aspirin and statins.

Prevention of complications :
• 5) Screening (investigation) for early
detection of micro-vascular complications
• a) Opthalmoscopy
• b) Urine examination for micro-albuminuria
• c) Regular foot / leg examination

Advantages of Exercise
• 1) Reduces blood sugar
• 2) Reduces insulin and oral drug
requirement to control BSL
• 3) Help in reducing weight
• 4) In type II, some patients can be
managed only with diet and exercise

Advantages of Exercise
• 5) Increased good – HDL (high density
lipoprotein) cholesterol and decreased
bad – LDL cholesterol level.
• 6) Other benefits – improvement of blood
circulation in legs, increased stamina and
improve the quality of life.

Calorie requirement :
• 1) Normal weight with heavy manual work
– 35 cal/kg/day
• 2) Normal weight with sedentary life – 30
cal/kg
• 3) Overweight with sedentary life – 20
cal/kg
•

3 Indices
• 1) waist circumference
• Men < 94 cm
• women < 80 cm
•
• 2) waist – hip ratio
• Men < 0.9
• Women < 0.85

3 Indices
• 3) BMI – Body mass Index = Weight in Kg
divided by Height in meter square
• between 18.5 to 30 = 18.25

American Diabetic Associations Criteria
:
• Target values
• 1) Blood sugar
• i) Fasting blood sugar : 80 – 110 mg %
• ii) 2 hours after post glucose : 120 – 140
mg %
• iii) GHb A1C (glycosulated Hb) < 6 %
(patient can not manipulate.)

• 2) Cholesterol
• i) LDL cholesterol (bad) < 100 mg/100 ml
• ii) HDL cholesterol (good) > 45 mg/100 ml
• iii) Triglycerides < 200 mg %
•

• 3) B.P.
• i) SBP < 130 mm of Hg
• ii) DBP < 85 mm of Hg

OHA : Oral hypoglycemic Agents
• A) Sulphonylurea
• 1) Tolbutamide – Tab Restinon : 500 mg –
BD/TDS – weak and short acting
• 2) Chlorpropamide – Tab Diabenase : 100
mg – OD can cause dangerous
hypoglycemic attacks and Jaundice.

• 3) Glybenclamide – Tab Daonil / Euglucon
5 mg OD / BD
• Potent but slow acting
• 4) Glipizide – Tab Glynase – 5mg OD/BD
• Fast acting

• 5) Glyclazide – Reclide 40 mg, 80 mg Tab
Diamicron – 80 mg OD / BD
• Antiplatelet action (this is additional
advantage)
• 6) Glymeperide – Glypride : 1 to 2 mg OD
– longer duration of action.
•

• B) Biguanides
• 1) Metformin : Tab Glyciphase 500 mg
OD/TDS -- Use in obese patient.
• 2) Acarbose – Tab Glucobay – 50 mg OD
/BD -- Blocks the absorption of glucose
from intestine. Hence used to treat post
prandial hyperglycemia.

• C) New Drugs in Market
• 1) Repaglynide -- Eurepa : 1-2 mg BD –
Rapid action
• 2) Rosiglutazone – Rezult : 1-2 mg BD –
hepatotoxic
• 3) Pioglitazone – Pioz : 15-20 mg BD –
hepatotoxic

Prevention of sulphonylurea
induced hypoglycemia.
• 1) Do not miss meal
• 2) Do not suddenly increased exercise.
• 3) Avoid alcohol

Prevention of sulphonylurea
induced hypoglycemia
• 4) Elderly patient can suddenly go into
hypoglycemic stage, without warning
symptoms, prefer weaker OHA like
Restinon or Glynase.
• 5) Try to decrease dose of sulphonylurea
from time to time.

Biguanides :
• Phenformin banned because this drug can
cause lactic acidosis – which can be fatal.
• Met formin (glyciphase) – useful in abese
patient because it causes weight loss.
• Can be combined with other "OHA' or
insulin.

Biguanides :Side Effects
• Occasional diarrhea or heart burn hence
even always after food.
• Like sulphonylurea group – It has no
action on pancreas.
• But acts by suppressing release of
glucose from liver

2) Glytazones
• They are called as insulin and reduced the
dose of insulin.
• Combined with other "OHA' and should
never be used alone.
• Problems --1) Very costly, can caused
increase in weight and so don’t used in
obese patient.2) Pedal oedema and
puffyness of face is common.

2) Glitazones
• Hepatotoxicity is common side effect, so
LFT should be done frequently.
• Drugs are new hence long term side
effects not known.
• Biggest advantage – used in the patient
who are on insulin, to reduce the dose of
insulin or in patients who are taking
maximum dose of sulphonylurea or
Biguanides.

Management of DM
• 1) First 2 months only Diet Control & Exercise
• 2) If Uncontrolled -- & Patient with Normal weight
– Start with Sulphonylurea group
• 3) If still Uncontrolled ,add Bigunides like
Metformin
• 4) If still Uncontrolled ,Give Glitazone or
Acarpbose
• 5) If still uncontrolled ,start Inj.Insulin

Precriptions
• In mild DM :
• A) P. P. Blood sugar – 160 – 200 mg %
(Mild DM)
• 1) Strict diabetic diet
• 2) Regular exercise
• 3) Weight reduction in obese patient

Prescriptions
• Then
• Blood sugar fasting and P.P. after 15 days
• If normal – check after every 6 month.
• But if still blood sugar is high – start OHA

Prescriptions
• 1) In obese –
• Tab – Glyciphage – ½ OD after food or in Thin
patient.
• Tab – Semi Diaonil – 1 OD before food.
• If fasting blood sugar is normal but P.P. high
then
• Tab Glukobay / Acarbose – 50 mg TDS
• with first morsel of meal (Remember costly drug)

Prescriptions
• B) Moderate DM
• If PP blood sugar > 250 mg %
• 1) In obese patient – Tab – Glyciphage 1
OD
• 2) In thin patient – Tab Glynase 1 OD

Prescriptions
• How to increase Dose.
• A) In obese patient
• Tab glyciphage 1 OD – BD – TDS
• Then -- Tab Glyciphage 1 – 1 – 1
• Tab Daonil – 1OD /BD/TDS
• Then Tab – Glyciphage 1 – 1 – 1
• + insulin

Prescriptions
• B) In thin patients
• Tab – Daonil ½ OD – 1 OD – BD – TDS
• Then Tab Daonil 1 – 1 – 1
• Tab Glyciphage 1 OD – BD – TDS
• Then Daonil 1 – 1 – 1
• + Insulin

Insulin Dose :
• Urine sugar
• Blue x Omit Insulin
• Gree + 10
• Yellow ++ 20
• Orange +++ 30
• Red ++++ 40
• Check urine sugar before breakfast, lunch and
dinner and adjust dose of plane insulin.

Lente Insulin
• For single daily injection
• Dose of lente – 2/3 of total units of plane insulin
• e.g. 1) 50 years old male patient urine sugar –
• breakfast – Green 10
• lunch - yellow 20
• Dinner - green 10
• 40 x 2/3 = 80/3 = 27 units
• If daily dose of lente > 40 units, then
• 2/3 before breakfast and ½ before dinner.

Lente Insulin
• 2) 60 years Male patient
• breakfast – Green 10
• lunch - orange 30
• Dinner - yellow 20
• 60 x 2/3 = 120/3 = 40 units
• 40 x 2/3 = 27 – before breakfast (40 – 27 = 13)
• 13 units – before dinner / lente insulin
• If total insulin > 80 – 100 units then start human insulin
• Dose of human insulin is < 30 % than bovine insulin
•

Types of Insulin
No Type Onset Peak Duration
1 Short acting
Actrapid
½ - 1 hr. 3 – 4 hrs. 6 – 8 hrs.
2 Intermidiate acting
– Lente I
1 – 2 hr. 8 – 10 hrs. 20 – 24
hrs.
3 Long acting I –
Ultra – lente
3 – 6 hr. 12 – 18
hrs.
24 – 36
hrs.
4 Pre mixed -
mixtard
½ - 1 hr. 8 – 10 hrs. 20 – 24
hrs.

Diet for DM (Anti diabetic diet)
• No – Sugar all sweets, cakes, sweet
biscuits, jam, honey, sweet drinks, sweet
fruit ( mango and grapes)
• Restricted – Chapati, Roti, Bread
• Plenty – All leafy vegetables, vegetable
and tomato soups, cucumber, brinjal,
cauliflower, ladyfinger, butter milk, all
types of salad.

Diet for DM (Anti diabetic diet)
• Note :
• 1) Regular timing and restricted quantity of
meal.
• 2) Careful in festival parties.
• 3) No starving for longer period.
• 4) Avoid alcoholic drinks

DM -- Caution
• 5) Always keep the sugar or biscuits in
pocket and used it with slightest
symptoms of hypoglycemia – as
• i) sweating ii) palpitation iii) hunger iv)
irritability vi) slurred speech

DM -- Caution
• 6) Identity card in pocket with the note –
• I am a diabetic. If I found unconscious
take me immediately to hospital and give
25 % dextrose IV.

DM -- Caution
• 7) Care of feet – Wash, dry clean feet and
sprinckled lot of talcum powder.
• 8) Avoid walking bear foot even at room.
• 9) Wear soft cotton socks and canvas shoes
• 10) New foot wear with care because of shoe
bites.
• 11) Cut nails – very carefully and after bath to
make them soft.

Additional treatment for diabetes:
• 1) Cap Becozine – 1 OD (B plex & zinc)
• In severe long D.M. or associated with
peripheral neuritis.
• For nocturnal emissions in young boys
•
• 2) Tab Bio – E – 400 mg OD
• Tab Antoxid – 1 BD

Ayurvedic Medicines
• Diabetes Mellitus with obesity
• ( Santarpanajanya Prameha)
• Nephritis,Kidney or Urine problems –
Chandraprabha tab
• Asanadi kadha,Jambvasav, Pugapak

Ayurvedic Medicines
• i) Madhumehari Yoga (B) 2Tab. 3 times a
day
• (ii) Madhutard (Zandu) one sachet in a glass
of water before
• meals.
• (iii) Trivangashila (Zandu) 2 to 4 Tab. 2 times a
day before meals.
• (iv) DBT (Sharangdhara) 2 tab. 2 times day.
•

Thyroid gland

Throid System

Throtoxicosis

Thyroid Problems at Puberty
• Simple Goiter -- Young girls at puberty
• C/O
• Swelling in front of neck.
• Swelling – Soft, diffuse or nodules, it is
painless, non tender and more up and
down with deglutition.
• There are no other symptoms of hyper or
hypothyroidism.

Thyroid Problems at Puberty
• Treatment Assurance
• 1) This is harmless and regress
automatically.
• 2) T Eltroxin 100 mg TDS x 3 months
• Then 1 BD x 1 year
• 3) Soft diffuse goiter – regress
automatically.
• But if nodules -- Adv – Thyroidectomy

Hyper -Thyroidism – Thyrotoxicosis
• Usually in females
• C/O Rapid and excessive loss of weight, in spite
of normal appetite. Weight loss with reduce
appetite – T.B.
• Weight loss with excess appetite – D.M.
• Can not tolerate hot climate. Sweat excessively.
Fan use in even winter season.
• Palpitation

Hyper -Thyroidism – Thyrotoxicosis
• O/E – Tachycardia – Even after resting or
during sleep, swelling of thyroid gland,
Exopthalmus. Fine tremors of out
stretched hand.
• Adv – T3, T4 increase and TSH decrease

Hyper -Thyroidism – Thyrotoxicosis --
Treatment
• 1) Tab – Neomercazole 5mg – 2 TDS
(Carbimazole)
• Till TSH is normal or symptoms are under
control then 1 TDS x 1 year
• 2) Tab Ciplar 10 mg – TDS (To control
palpitation or tachycardia)
• 3) T Alprax – 0.25 mg BD (Alprazolam)-
Tranquilizer

Hyper -Thyroidism – Thyrotoxicosis --
Treatment
• Note : If patient can not be maintain or
control with medicine even after 1 year or
if there are recurrence then refer to
Endocrinologist to decide for
• a) Drug therapy
• b) Radio active Iodine therapy
• c) Surgery

When Surgery for Hyperthyroidism?
• i) Inadequate response to medical
treatment.
• ii) Large goiter
• iii) serious thyrotoxicosis
• iv) Intolerance to Neomarcazole

Ayurvedic Medicines
• Lymphadenitis, Tumour ( Gandamala,
Galaganda,Granthi) –
• Kanchanar Guggul

Ayurvedic Medicines
for Hyperthyroidism
• a) Kanchanar Guggulu 2 Tab. 3 times a
day.
• b) Raktavardhak 2 tablespoon 2 times a
day.
• c) Prasham (AYR) 4 tablespoon with equal
amount of water 2
• times after meals.

Radioactive Iodine
• Radio active iodine – treatment is
preferred in following conditions
• i) Age – 45 years
• ii) Recurrency after surgery
• iii) High operative risk patient

Hypothyroidism (Myxoedema)
• i) Puffiness of face – Generalize but
• ii) Sight edema over feet
• iii) Unexplained and rapid increase in
weight
• iv) Physical and mental slowing
(constipation and lethargy)

Symptoms of Hypertension

Myxoedema

• v) Intolerance to cold temperature –
sweater even in summer
• vi) Loss of sweating and dry skin
• vii) Hoarseness of voice.

• O/E
• Bradycardia
• Ankle jerk – After a quick contraction
there will be slow relaxation.
• Adv – i) T3, T4 decreases ii) TSH
increases (-ve feedback mechanism)

Hypothyroidism (Myxoedema) –
Treatment
• Treatment is simple but life long.
• Tab Eltroxin 100 mg ob – 1 month
• Repeat TSH, still increase tab every
month max 2 or 3 tab.
• 1 – 1 ½ - 2 – 2 ½ - 3

Ayurvedic Medicine
for Hypothyroidism
• Punarnava Guggulu 2 Tab. 3 times a day.
• (2) Kanchanar Guggulu 2 Tab. 3 times a
day.
• (3) Bhallatakasava 2 tablespoon with
equal amount of water 2
• times a day.

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urvedic & Modern
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Endocrine system problems in GP

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