Sunday, December 4, 2022

How Is Hormone Replacement Therapy Used To Treat Diabetes

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Dr Deborah Lee Dr Fox Online Pharmacy Discusses The Link Between Menopause And Type

What is hormone replacement therapy?

Doctors have been reluctant in the past, to prescribe hormone replacement therapy for perimenopausal women with type-2 diabetes . This was because diabetes is known to increase the risk of cardiovascular disease, and HRT was also believed to do the same.

However, heres the good news. Things have changed. Diabetes is no longer a definitive reason to withhold HRT. Many in the medical profession, and diabetic women themselves, remain unaware this is the case. Read on below and find out the reasons why.

Please note that there is a lack of evidence about the use of HRT for women with type-1 diabetes. These women need specialist advice from their specialist Diabetes and Menopause care providers about how to manage their menopause and the use of HRT.

Estrogen Targets Pancreatic And Gut Cells

For their study, Philippe and colleagues administered estrogen to postmenopausal mice.

While previous studies have primarily focused on how estrogen affects the insulin-producing cells of the pancreas, this latest study also looked at how the hormone impacts cells that produce glucagon, which is a hormone that increases blood glucose.

Indeed, says Philippe, if the pancreas secretes insulin, it also secretes glucagon, a hormone with the opposite effect: insulin captures sugar, while glucagon releases it. Diabetes is therefore due to an imbalance between these two hormones controlling the sugar level in the blood.

The new study revealed that the alpha cells of the pancreas, or cells that secrete glucagon, are highly sensitive to estrogen the hormone causes them to release less glucagon, but more of a hormone called GLP1.

And, notably, GLP1 is also released by the intestine after eating it encourages inulin secretion, blocks glucagon secretion, and increases feelings of fullness.

Indeed, the gut harbors cells called the L cells that are very similar to pancreatic alpha cells and whose main function is precisely to produce GLP1, explains first study author Sandra Handgraaf, also of the Faculty of Medicine at the University of Geneva.

The researchers were able to confirm their results in human cell lines.

Effect Of Menopause On Insulin Resistance

The preponderance of the evidence argues for a role of menopausal 17-estradiol deficiency in the increased risk of type 2 diabetes.

What can we learn from animal models about the role of menopause in predisposing to insulin resistance? First, insulin resistance is readily detectable in ovariectomized mice . Observations in genetic mouse models are consistent with the concept that decreased E2 action via ER is the predominant mechanism that produces insulin resistance after menopause . In skeletal muscle, decreased ER action may alter mitochondrial fission, decreasing mitochondrial fatty acid oxidation and oxygen consumption and resulting in oxidative stress and insulin resistance . In liver, decreased ER activation allows hyperinsulinemia to promote liver triglyceride deposition, and fails to suppress liver triglyceride export, which results in hepatic steatosis and insulin resistance . Finally, the decrease in ER action in macrophages and adipose tissue also contributes to inflammation, insulin resistance, and atherosclerosis.

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Symptoms And Effects Of Menopause

Menopause is the time in a womans life when menstruation ceases, signaling the end of her reproductive ability. The timing of menopause varies widely, but this event often occurs naturally in women in the fourth or fifth decades of life, at a mean age of 51 years. Certain medical or surgical conditions may induce the cessation of menses before this age. If menopause occurs before the age of 40 years, it is considered premature.

The STRAW classification proposed by the American Society for Reproductive Medicine depicts the natural transition in a female’s life from the reproductive years to the time of menopause.

The reproductive years are divided into early, peak, and late and are characterized by regular menstrual cycles . This is followed by the stage of menopausal transition, which earlier on is characterized by a variable cycle length that is more than 7 days different from normal. During the latter stages of this transition phase, women experience intervals of amenorrhea of more than 60 days. When this duration of amenorrhea lasts for up to 12 months, it is classified as postmenopause. The stage of perimenopause spans from the beginning of the stage of menopause transition up until the completion of 1 year following the final menstrual period.

The Outlook For Women

Effect of Hormone Therapy on Muscle Mass in Postmenopausal ...

As women get older, hormone changes before and during menopause often cause hot flashes, irritability, and trouble sleeping. Not only do these drops or spikes in the hormones impact your mood and life, but they can also affect your blood sugar. These ups and downs mean may mean you have to test your levels and make adjustments more often.

If you have type 1 diabetes, you may notice low blood sugar levels more often as you get closer to menopause. This can be a sign that your hormones are going down and you may need less insulin. Itâs important to know the difference between low blood sugar and moodiness or other perimenopause symptoms.

You may reach menopause early if you have type 1 diabetes, but if youâre overweight and have type 2, your changes could start later. Thatâs because estrogen doesnât drop as quickly in heavier women.

As your bodyâs changing, itâs easy to confuse signs of menopause with symptoms of high or low blood sugar. Dizziness, sweating, irritability, and trouble concentrating could all result from hormonal changes or from blood sugar thatâs too high or too low. The only way to know for sure — and the safest thing to do — is to test it. But checking too often can take an emotional toll. If youâre worried, your doctor or diabetes educator can help you figure out how often to do it.

If you canât get your blood sugar levels where they need to be, your doctor might suggest hormone replacement therapy .

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Take Care Of Yourself

Eating well and staying active are always important for managing diabetes, but this is especially true during menopause. More weight gain during this time can make your diabetes harder to manage.

Eat a variety of fruits, vegetables, whole grains, lean protein, and low fat dairy. Try to be active for at least 30 minutes daily to prevent more weight gain and to manage your diabetes.

How Do You Determine Which Hormones I Need

Before starting hormone replacement therapy, your specialist at Thyroid Endocrinology and Diabetes performs a comprehensive physical exam and asks you questions about your medical history and current symptoms.

Once your diagnosis is confirmed, your specialist develops a HRT treatment plan to address your hormonal imbalance. Each therapy is unique and tailor-made for your particular hormonal deficiency and its resulting symptoms.

To learn more about how you can benefit from hormone replacement therapy at Thyroid Endocrinology and Diabetes, call or use the online booking tool to schedule an appointment.

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Hrt Does Not Cause Weight Gain

Weight gain at the menopause is related to age and lifestyle factors. An increase in body fat, especially around the abdomen, can occur during menopause because of hormonal changes, although exactly why this happens is not clear. Normal age-related decrease in muscle tissue, and a decrease in exercise levels, can also contribute to weight gain.

Most studies do not show a link between weight gain and HRT use. If a woman is prone to weight gain during her middle years, she will put on weight whether or not she uses HRT.

Some women may experience symptoms at the start of treatment, including bloating, fluid retention and breast fullness, which may be misinterpreted as weight gain. These symptoms usually disappear once the therapy doses are changed to suit the individual.

Drug Treatment Of Diabetes Mellitus

Hormone Replacement Therapy with SottoPelle & Gino Tutera MD

, MD, New York Medical College

There are two types of diabetes mellitus

Doctors must be careful when treating diabetes with drugs because insulin and many of the drugs given by mouth can make blood glucose levels too low in the blood. Hypoglycemia is most often caused by drugs taken to control diabetes. Much less common causes of hypoglycemia include other… read more ).

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Hormone Therapy In Women Who Have Diabetes

Often women with diabetes have fluctuating hormone levels that may cause other health issues, especially during menstruation and menopause. Hormonal imbalances have been linked to health conditions associated with diabetes, such as heart disease and kidney problems. Discover more about hormone therapy in women who have diabetes and how it may help.

If you have diabetes, talk to your doctor about the benefits and risks of hormone therapy. The right balance of hormones can improve your blood sugar control and help prevent diabetes-related complications such as heart disease, kidney disease and more. Hormone therapy and the right lifestyle choices can make a big difference in the quality of your life.

Evaluation For Hormone Therapy

All candidates for HT should be thoroughly evaluated with a detailed history and complete physical examination for a proper diagnosis and identification of any contraindications.

Baseline laboratory and imaging studies before administering HT include the following:

  • Hemography

  • Fasting lipid profile

  • Blood sugar levels

  • Serum estradiol levels: In women who will be prescribed an implant and in those whose symptoms persist despite use of an adequate dose of a patch or gel

  • Serum follicle-stimulating hormone levels: To monitor women taking oral preparations for symptomatic control, especially those with premature menopause

  • Ultrasonography: To measure endometrial thickness and ovarian volume

  • Electrocardiography

  • Papanicolaou test

  • Mammography: Performed once every 2-3 years and annually after the age of 50 years

Endometrial sampling is not required in routine practice. However, the presence of abnormal bleeding before or during HT should prompt consideration of ultrasonography to check endometrial thickness , followed by outpatient Pipelle sampling and hysteroscopy. In women with a tight cervix, formal hysteroscopy and dilation and curettage under general anesthesia are advised.

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Reasons To Consider Hormone Replacement Therapy

Getting older is rarely a walk in the park. While some people seem to bypass the worst effects of aging, for most, the natural declines associated with passing years create unique combinations of symptoms you likely wish you could do without.

Hormone replacement therapy has long been used by menopausal women to moderate the symptoms of reduced estrogen production. More men are learning that extreme falloff of testosterone can create its own male menopause conditions, and that HRT is an alternative treatment for some.

While there are some statistical risks of side effects, for many people the benefits of HRT lead to a better quality of life.

The HRT experts at AM Diabetes & Endocrinology Center can help you decide if this treatment is right for you. Contact Dr. Kashif Latif and his team today to arrange your personal consultation. Here are five reasons you may want to consider HRT.

Ht Indications Contraindications And Adverse Effects/risks

Hormone Replacement Therapy

Indications

Indications for hormone therapy can be symptomatic or preventive. However, the application of HT to prevent sequelae of menopause is controversial, although some consensus has been reached regarding the use of HT to relieve symptoms.

The following are common clinical indications for prescribing HT:

  • To relieve vasomotor symptoms

  • To improve urogenital symptoms

  • To prevent osteoporosis

Contraindications

No absolute contraindications of HT have been established. However, relative contraindications exist in certain clinical situations, such as patients with the following findings:

  • A history of breast cancer*

  • A history of endometrial cancer*

  • Porphyria

  • Endometriosis

  • Fibroids

* Note that many clinicians do not prescribe HT for women with a previous history of breast or endometrial cancer.

Adverse effects and risks

Possible transient adverse effects are as follows:

  • Nausea

  • Bloating, weight gain , fluid retention

  • Mood swings

  • Breakthrough bleeding

  • Breast tenderness

Potential risks of HT in postmenopausal women include the following:

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Choice Of Insulin Type And Dose

The choice of insulin is complex. Doctors consider the following factors when deciding which insulin is best and how much insulin to use:

  • How well the body responds to the insulin it makes

  • How much the blood glucose level rises after meals

  • Whether other antihyperglycemic drugs can be used instead of insulin

  • How willing and able people are to monitor their blood glucose levels and adjust their insulin dosage

  • How often people are willing to inject insulin

  • How varied daily activity is

Insulin injections can affect the skin and underlying tissues. An allergic reaction, which occurs rarely, causes pain and burning, followed by redness, itchiness, and swelling around the injection site for several hours. Very rarely, a person may have an anaphylactic reaction Anaphylactic Reactions Anaphylactic reactions are sudden, widespread, potentially severe and life-threatening allergic reactions. Anaphylactic reactions often begin with a feeling of uneasiness, followed by tingling… read more after injection of insulin.

What Other Information Should I Know

Keep all appointments with your doctor and the laboratory. You should have a complete physical exam, including blood pressure measurements, breast and pelvic exams, and a Pap test at least yearly. Follow your doctor’s directions for examining your breasts report any lumps immediately.

If you are taking hormone replacement therapy to treat symptoms of menopause, your doctor will check every 3 to 6 months to see if you still need this medication. If you are taking this medication to prevent thinning of the bones , you will take it for a longer period of time.

Before you have any laboratory tests, tell the laboratory personnel that you take hormone replacement therapy, because this medication may interfere with some laboratory tests.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

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How To Stay Healthy In Midlife

As it turns out, the things you do to get a handle on diabetes as you enter midlife arenât that different than what youâve been doing all along to stay healthy:

  • Pay attention to your diabetes. That means you need to keep track of your blood sugar levels and talk to your doctor if theyâre are all over the place and you canât figure out why. Keep a record of your results and go over them with your doctor.
  • Watch your weight.
  • Eat a healthy diet. Get plenty of vegetables, choose whole-grain foods, and opt for lean proteins and low-fat dairy.
  • Get at least 30 minutes of exercise a day. It will give you more energy and boost your mood. Youâll get the most benefit by doing a combination of an exercise that ups your heart rate — like brisk walking — along with strength training, like lifting weights.

Hormone Replacement Therapy May Cause Side Effects Tell Your Doctor If Any Of These Symptoms Are Severe Or Do Not Go Away:

Menopause: Hormone Replacement Therapy
  • headache
  • changes in sex drive or ability
  • nervousness
  • brown or black skin patches
  • acne
  • swelling of hands, feet, or lower legs
  • bleeding or spotting between menstrual periods
  • changes in menstrual flow
  • dark-colored urine
  • light-colored stool

Hormone replacement therapy may increase the risk of developing endometrial cancer and gallbladder disease. Talk to your doctor about the risks of taking this medication.

Hormone replacement therapy may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration’s MedWatch Adverse Event Reporting program online or by phone .

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Added Benefits Of Hrt

HRT reduces the risk of various chronic conditions that can affect postmenopausal women, including:

  • diabetes taking HRT around the time of menopause reduces a womans risk of developing diabetes
  • osteoporosis HRT prevents further bone density loss, preserving bone integrity and reducing the risk of fractures, but it is not usually recommended as the first choice of treatment for osteoporosis, except in younger postmenopausal women
  • bowel cancer HRT slightly reduces the risk of colorectal cancer
  • cardiovascular disease HRT has been shown to reduce cardiovascular disease markers when used around the time of menopause.

Comparison Of Oral And Transdermal Estrogen Delivery

Comparison of transdermal E2 and oral CE delivery. Transdermal E2 delivery provides the ability to administer unmetabolized E2, at lower doses, directly to the blood stream, with enhanced delivery to nonhepatic tissues and with minimal stimulation of hepatic protein production, but lower suppression of HGP and the low-density lipoprotein /high-density lipoprotein cholesterol ratio compared with oral estrogen delivery. In contrast, oral estrogen delivery leads to first-pass hepatic metabolism and necessitates higher doses of estrogen to achieve efficient delivery to nonhepatic tissues. Oral estrogen delivery also leads to increased hepatic production of coagulation and inflammatory factors, but better suppression of HGP and the LDL/HDL cholesterol ratio than oral delivery. TG, triglycerides.

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Mechanisms Of Antidiabetic Actions Of Mht

Most studies suggest that MHT decreases abdominal fat deposition and that this contributes to MHTs antidiabetic action. However, in the HERS and WHI trials, the diabetes prevention observed in women assigned to MHT was independent from the observed reduction in BMI and waist circumference . Similar observations were made in large observational studies such as the Nurses Health Study and E3N . Therefore, available evidence suggests that estrogens improve glucose homeostasis by acting directly on ERs in liver and skeletal muscle to improve insulin sensitivity, or on ERs in pancreatic islets to improve insulin secretion , as can be observed in rodent models . It should be emphasized that the oral or transdermal administration of CE or E2 does not mimic the cyclical ovariansecretion of E2. Thus, the antidiabetic effect of MHT may involve mechanisms that are similar to or different than those of endogenous E2 and are not necessarily mirroring the defects observed during menopause.

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