Ageing and Hormonal Changes

Dr Anirudh Shetty is Senior Endocrinologist, Narayana Health, Bengaluru. He has an experience of over 15 years in endocrinology. He specialises in Diabetes Mellitus and its management. He has done his MD in Internal Medicine and DM in Endocrinology. 

• Diabetes mellitus type II is prevalent in India with its incidence as high as 7.7 crore individuals. India is also known as the Diabetes capital of the world. 
• In simple words, on consumption of food, the food is broken down into sugars. This sugar enters the blood, insulin allows the sugar to enter the cell and provide energy, leading to a reduction in the amount of blood sugar levels in the blood. Insulin acts like a key which opens the lock and lets the blood glucose enter the cells for the purpose of energy production. 
• Insulin is required for glucose to enter into the cell and thereby produce energy. 
• Whatever we eat is broken down into glucose for energy and the pancreases secrete insulin which attaches itself via receptors to facilitate the movement of glucose into the cells and that is used by the cell as energy. 
• Without insulin, the glucose cannot exert into the cells. And hence, the sugar levels rise in the blood and the cells do not get adequate glucose for energy production and functioning. This can happen if:

1. Insufficient amount of insulin is being secreted by the pancreas

1. The cells are resistant to the action of insulin 

Types of diabetes:

1. Type I DM: there is no production of insulin from the pancreas. This is commonly seen in children. Peak incidence is 9-14 years. 

1. Type II DM: the pancreas does not produce enough insulin leading to an insulin deficiency. In these cases, insulin resistance also plays a role. 
2. Gestational diabetes: diabetes that occurs during pregnancy. 

• Risk factors for Diabetes Mellitus:

• Family history 
• Overweight/ obese 
• Unhealthy diet 
• Inadequate physical activity 
• Old age 

• Symptoms for Diabetes Mellitus:

These symptoms are more prominent in patients with very high blood sugar levels. 

• Excessive thirst
• Increased hunger 
• Sudden weight loss 
• Fatigue 
• Frequent urination

Many times, the symptoms may also be absent and diabetes can be an incidental finding during equal medical examination and investigation. 

• Diabetic patients are also at an increased risk of getting infections. This can be a urinary tract or a respiratory tract infection. 

• The normal fasting blood glucose levels range between 70-100 mg/dL
• 2 hour postprandial (post meal) blood glucose levels range less than 140 mg/dL
• The individual is said to be diabetic or freshly diagnosed with Diabetes Mellitus Type II if the fasting blood glucose levels are above more than/ equal to 126 mg/dL and post prandial blood sugar levels are more than/ equal to 200mg/dL

• HbA1c is the average of 3 months of blood glucose levels. This helps us identify if the individual is normal, pre diabetic, diabetic, poorly controlled diabetic. 

• Normal individual: 

1. HbA1c < 5.7%

1. Fasting BS <99 mg/dL
2. PP BS <140 mg/dL

• Pre diabetic individual:

1. HbA1c: 5.7 – 6.4%

1. Fasting BS: 100-125 mg/dL
2. PP BS: 140-199 mg/dL

• Diabetic individual:

1. HbA1c > 6.5%

1. Fasting BS > 126mg/dL
2. PP BS > 200mg/dL

• Complications associated with Diabetes Mellitus:

• Renal failure 
• Cardiovascular problems
• Neurological problems 
• Ophthalmic/ eye problems 
• Diabetic foot: you should wash your feet regularly and check your toes and inter digit space for any wound/ ulcer 

• Management of Diabetes Mellitus includes 04 aspects 

1. Lifestyle modification
2. Diet 
3. Medication: you should be compliant with your medication as described and advised by your doctor. Timely consumption of medication goes a long way in keeping your blood glucose under control.  
4. Self monitoring of blood glucose 

• Challenges for people with diabetes are primarily due to day to day and inter- day variation in the blood glucose levels. Making it difficult to detect low and high glucose levels during the day and tough to prevent the complications. 

• Glycemic goal for diabetic patients include according to the American Diabetes Association:

1. HbA1c: less than 7%

1. Glucose levels pre meal: between 80 mg/dL to 130mg/dL
2. Post prandial BS less than 180 mg/dL

• Self monitoring of blood glucose (SMBG) at home is an important step and has shown to be:

1. Effective in blood glucose control in both type I and type II diabetic patients on insulin. 

1. Monitoring food intake and exercise 
2. Preventing low blood glucose episodes 
3. Helps in adjusting the medication 
4. Also plays an important role in achieving the glycemic goals
5. It also helps you underdone which foods raise/ spike your blood sugar levels and which food items keep your blood sugars under control

• Foundation of a healthy lifestyle includes:

• Good diet: quality > quantity. Your plate should have 1/2 plate of vegetables, 1/4 plate of starch and 1/4 plate of protein
• Regular exercise. You should be active for 30-60 minutes per day. Or 20 minutes at a time 3 times per day. 
• Sleep: 7- 8 hours of uninterrupted sleep  
• Stress management 

• Every diabetic patient should try to keep their “ABC” under control, which is: 

HbA1c less than 7%

BP less than 140/ 90 mm go Hg

Cholesterol (LDL) less than 100mg/dL

• Symptoms of low blood sugar include:

• Sweating 
• Trembling 
• Dizziness 
• Mood changes 
• Hunger 
• Blurring of vision 
• Execrated fatigue 

These are common when your meal is either delayed/ skipped or when you skip your medication. 

• Physiological and hormonal changes in our bodies that occur as we age include:

1. Menopause: fall in the oestrogen and progesterone production following the cessation of the ovulation function in females. This can lead to deterioration of the lipid profile, thereby also increasing the cardiovascular risks. It also leads to cages in the adipose tissue distribution and bone mineral density loss. 

1. Andropause: gradual decline in the testosterone levels as the men age. It begins around the 35- 40 years of age and persists till death. 
2. Adrenopause: gradual reduction on the DHEA and DHEA-S which is secreted by the adrenal glands 
3. Somatopause: gradual reduction in the growth hormone- released by the pituitary gland- with age. The reduced levels of growth hormone predisposes individuals to increased risk of obesity, decreased lean body mass and decreased bone density   

The pituitary gland is known as the master gland which controls the release of the majority of hormones.

• These hormonal changes predispose the elderly to increased risk of:

• Diabetes mellitus 
• High blood pressure 
• Low muscle mass 
• Increased body fat mass 
• Decreased bone density 
• Increased risk of body fat/ obesity 

Changes in the body as one ages is not just due to the hormonal changes but is also attributed to the decreased activity as age progresses. 

Osteoporosis is seen more commonly in females than males. Leading to increased risk of fractures due to fall. This can be reduced/ prevented by:

• Nutritious diet 
• Calcium rich diet 
• Smoking cessation 
• Increased physical activity to promote strength and balance 
• Correcting visual deficits, if any