Endocrinology

A: Obesity results when calorie intake exceeds expenditure. The source of calories doesn't matter much (fruit or otherwise).

In the context of a genetic predisposition to diabetes (e.g. one family member is diabetic); obesity often leads to diabetes mellitus.

Certainly, if your calorie intake exceeds expenditure over a long period of time, you could become obese and increase your risk of encountering diabetes.

However, since neither a family history has been given, nor information about the readers lifestyle, it is impossible to give a definite prediction.

Contributed by Dr Alex Fok, eMenders, Endocrinologist

A: One stops growing taller when the growth plates (epiphyses) of the bones have fused. This is readily determinable by doing an x-ray of the knee for epiphyseal fusion. Once growth plates are fused, taking more food will not benefit height, only girth.

Breast size is determined largely by genetics and by body fat levels. Without specific information, this question cannot be answered satisfactorily.

Contributed by Dr Alex Fok, eMenders Endocrinologist

A: Benil (or Gliblenclamide) stimulates the beta cells of the pancreas to release insulin. It has nothing to do with gastric juices.

Metformin works only in the presence of insulin. It is used in Type 2 Diabetes Mellitus. It decreases the liver production of glucose and increases insulin action (mechanism unknown). It does not stimulate the pancreas to produce insulin and has no effect on gastric juices. It does not create tolerance for glucose-related food.

Contributed by Dr Alex Fok, eMenders Dermatologist

A: If you are referring to a test kit similar to a pregnancy self-test kit, the answer is that there is nothing similar in the market for diabetes.

You can purchase a meter for testing glucose levels from a drop of blood obtained from your fingertip. They are available at most pharmacies. Most doctors would also have such a device in their clinics.

You should have this test done if you have a relative who is diabetic, are over 40 years of age, have experienced diabetes in a previous pregnancy, are overweight, or have been prescribed steroids.

Testing urine for sugar is not an accurate way of determining if you have diabetes, although I have had occasion to diagnose diabetes in patients who either notice ants around their urine or who taste their urine finding it sweet.

Contributed by Dr Lee Chui Tho, eMenders Dermatologist

A: The merits of such treatment depend on the clinical situation. Generally surgical debridement, followed by dressings are the mainstay of therapy. In deep seated wounds, in which dressing and debridement would result in "collateral damage" to healthy tissue, maggot treatment may be considered.

We are not aware of any hospitals in Singapore providing such treatment. There is a huge investment cost as the maggots used have to be medical grade (devoid of disease causing potential) and therefore have to be "farmed "in a sterile facility. The lifespan of maggots being very short, unused maggots go to waste. There is also the "yuck" factor which has to be overcome. In this respect using leeches for congested wounds after finger attachment is also viewed as unconventional.

In Malaysia, the Institute for Medical Research has been studying maggot debridement therapy (MDT) for the past few years.

Contributed by Dr Alex Fok, emenders Dermatologist

A: 1) The dents in your big toenails may be due to several factors: trauma, a skin disease affecting the skin at the base of your toenail, or even a hormonal problem such as thyroid disease. It is best that you consult your family practitioner to determine whether a dermatological referral is needed.

2) There are several possible causes of thickening of the nails: trauma to the nailbed, friction against footwear, fungal infection of the nail, inflammatory skin disease such as psoriasis and lichen planus, etc.

The first step to treating the problem is to obtain a diagnosis. For this, you will need to be assessed by a dermatologist who may order some laboratory tests on your nail, such as a culture of the nail for fungus, where necessary.

The visible effects of bleeding under the toenail would have resolved within months of the injury unless there has been permanent damage and scarring of the affected nailbed.

Contributed by Dr Cheong Lai Leng, eMenders Dermatologist

A: The blood glucose levels will be abnormal if the pancreas is producing insufficient insulin for the body. This abnormality can be detected on either a glucose tolerance test, which consists of consuming a drink containing 75 gm of glucose and checking the blood glucose level 2 hours later, or a fasting specimen of blood. The second method is not as good to determine whether one is producing sufficient insulin in most cases.

Abnormalities of the glucose levels can be classified either as diabetes or prediabetes, depending on the results. For either case, the patient may need to take medication, which depends on the level of glucose in the blood as well as the type of diabetes the patient is suffering from. For Type 1 diabetes, insulin is needed. For Type 2 diabetes, the patient is usually required to take tablets. Some of these tablets help the pancreas to produce insulin.

It is not advisable to take herbs, supplements or traditional medications to boost the production of insulin. As diabetes is a serious condition, one should consult a medical professional to make a diagnosis as well as determine the type of diabetes.

Contributed by Dr Peter Eng, eMenders Endocrinologist

A: In general, if the patients weight and BMI are over the acceptable limits, a weight reducing diet is recommended. Decreasing total calories, in particular fat calories, usually improves the patients blood glucose and cholesterol. Aerobic work (eg. walking, cycling) will also benefit the patient if his annual medical examination within the year shows that he has a clean bill of health.

For more specific issues, the patient should consult a doctor.

Contributed by Dr Alex Fok, eMenders Dermatologist