Meghana Kumar, MD

Image courtesy of https://blog.drseeds.com/thyroid-hormone-overview/

Thyroid hormone replacement is the mainstay of treatment for hypothyroidism, whether the hypothyroidism is caused by radiation, surgery, or Hashimoto’s disease (autoimmune destruction of the thyroid gland). The goal is to replace the body’s production of thyroid hormone in the most physiologic way possible. However, a quick internet search will reveal an overwhelming number of options for thyroid hormone replacement. In this article, we will break down the different brands of thyroid hormone available in the US and things to consider before selecting a formulation.

A normal thyroid gland produces 80% T4 (inactive thyroid hormone) and 20% T3 (active thyroid hormone). Various organs have enzymes which convert T4 to T3, which then mediates all the functions of thyroid hormone, from sleep to digestion to temperature regulation.

T4-only formulations:

Generic – Levothyroxine

Brand name – Synthroid, Levoxyl, Euthyrox, Unithroid, Tirosint

These medications are usually the first-line treatment offered. It is important to stay on the same brand or advise your doctor if you are prescribed a different brand than before. Different brands even at the same dose may have slightly different contents.

All these medications are comparable in effectiveness. Tirosint is notable because it comes in a gel capsule or solution form, which can help with medication absorption. Some patients may experience more stable thyroid levels upon switching from generic to brand name hormone.

T3 and T4 combination formulations:

Thyroid extract medications: Armour, NP Thyroid, Nature-Thyroid, WP Thyroid, Westhroid

Synthetic: Cytomel/Liothyronine (T3) plus one of the T4 medications listed above.

Most doctors are reluctant to prescribe thyroid extract medications (which are made from dried and powdered pig thyroid glands) because they do not simulate the normal human thyroid production closely. They tend to contain high concentrations of T3 which can cause highly variable levels and symptoms.  Prescribing T3 and T4 as separate pills allows the doctor to control the ratios of each.

A T3-only medication regimen is generally not prescribed.

There are a number of factors that go into selection of a thyroid hormone replacement. Your endocrinologist can talk to you further about which medication is the best choice for you, and why.

Meghana Kumar, MD

Glucometers have revolutionized the management of diabetes. Early glucometers were clunky, slow, and required large drops of blood. The oldest ones simply displayed a color that had to be correlated to a numeric chart. On the other hand, the sleek, pocket-sized devices of today are lightning-fast and accurate.

So it’s no wonder that self-monitoring of blood glucose has become the standard of care. At its best, it lights our path in achieving glycemic control. At its worst, it’s an influx of confusing data, a constant reminder of this condition. So how do we make sure the glucometer is an asset rather than a nuisance?   

5 things you should know about using a glucometer:  

  1. Timing matters. It’s not enough to merely check glucoses – your provider also needs a context for these glucose values. Make sure the date and time settings on the meter are correct, and if you keep a log, write the times alongside the values. Even better, make note of the relationship of the readings to meals. Checking pre-meal glucoses is a good place to start, and your doctor may want you to check 1-2 hours after a meal or overnight too.
  2. Clean hands, accurate readings. Wash your hands with soap and water – and dry thoroughly! Residue of certain substances (like fruit) can artificially raise your glucose reading. Water can make the glucose look lower than it really is. Alcohol swabs or hand sanitizer will work too in a pinch, but keep in mind that applying alcohol excessively may dry out your skin.
  3. Fingersticks don’t have to be a pain. Pricking on the side of the finger rather than the finger pad can help, since that region contains less sensory nerve endings, as can changing the lancet type or size. Alternate site testing (AST) refers to testing glucose from sites other than fingers – ie. Palm, forearm, thigh, abdomen. Ask your provider if your meter is approved for AST. Values from alternate sites tend to lag behind your actual blood glucose level, so the readings must be interpreted with caution.
  4. What to do when numbers don’t make sense. Each finger is giving you a different reading, or you’re getting vastly different readings only minutes apart – how frustrating! First, ensure that your test strips aren’t expired, the test strips were properly stored, and your hands are clean. Make sure you’re giving an adequate blood sample. Then give the control solution a try. This is the small bottle that comes with every new meter. Apply a drop of this solution on the test strip to verify the accuracy of the glucometer. Your endocrinologist can send a prescription of the control solution to your pharmacy (and remember, it has an expiration date, too).
  5. You can identify patterns too. Whykeep a log if the meter records all the glucoses? For one thing, it saves time at your appointment if the provider has a log to look through, leaving more time for us to discuss important management issues. But more importantly, a log helps you to recognize trends – like what that mid-afternoon vending machine treat does to your blood sugar.

Novo Nordisk is offering a free 90-day supply of insulin to those who have lost health insurance due to the COVID-19 pandemic AND has expanded their patient assistance program for discounted insulin. Ask your endocrinologist for more information to see if you may qualify.

Letal Garber, MS, RD, LD

Diabetes and Covid-19: What you need to know and tips on management

During a time of uncertainty, it’s easy to get stressed or panicked. Our practice stands by our philosophy that knowledge is power; the more informed you are, the better chances of a good outcome. Our goal is to propagate safety and minimize fear during this difficult time.

Here’s what we know about the connection of Covid-19 and Diabetes:

  1. People may be infected with the virus up to two weeks before developing symptoms.
  2. The most common symptoms are fever, fatigue, and cough.
  3. Most people recover from the virus, but the disease can be more dangerous to those who have chronic conditions such as Diabetes.
  4. This is especially true with pre-existing complications secondary to uncontrolled Diabetes, which could mean increased risk of infection and difficulty with healing due to poor circulation.
  5. If Diabetes is well managed, your risk of getting severely sick from Covid-19 is about the same as the general population.

Here’s what you can do to reduce your risk:

  1. General:
    1. Follow government and state guidelines for dealing with Covid-19.
    1. Do your part by staying home, wash hands, avoid touching your face, sneeze in tissues or your elbow, and sanitize commonly used surfaces.
    1. Practice social distancing and minimize contact with others.
      1. Keep your appointments by scheduling virtual visits! We are now offering telemedicine appointments with a simple click of a button. You can join the virtual appointment by clicking on the link sent to you via email or text. For those of you with upcoming appointments, if you don’t hear from us first, give us a call to change the visit to a virtual meeting.
  2. Medication Management:
    1. Make sure you maintain a stockpile of oral medications and/or insulin and keep these properly stored.
    1. Also keep enough inventory of testing supplies (test strips, lancets), ketone strips, alcohol wipes, glucose tablets and/or sugar-containing fluids such as juice for low blood sugars.
    1. You may want to ask for 90-day prescriptions with refills versus the typical 30-day prescription.
    1. Ask your insurance if they contract with mail order pharmacies to reduce need to leave the house.
    1. If you’re having difficulty affording your medication, investigate patient assistance programs and resources such as InsulinHelp.org. If you’re running low on insulin and/or can’t afford insulin, don’t go without it. Wal-Mart has mealtime and 24-hour insulin that doesn’t require a prescription, just ask your provider.
    1. Keep a stock of broth, jello, electrolyte drinks, canned or frozen foods in the event of acute illness.
  3. Lifestyle Management:
    1. Monitor your blood sugars regularly and send in your blood sugar data to your provider for adjustment of your medications.
    1. Aim for 3 balanced meals per day with lean protein such as beans, chicken, fish, nuts/seeds, complex carbs (whole wheat pasta, baked potato, peas), and many vegetables. Stay hydrated with water.
    1. Limit high carb snacks, chips, dessert and beverages and fried foods.
    1. Engage in “joyful movement” most days of the week (30 minutes of moderate activity 5 times per week at minimum). Think about what activities you enjoy: walking, aerobics, biking and stick to it!
    1. Practice self-care in order to manage stress and improve mental health. Be intentional about finding ways to relax whether it’s reading a new book, practicing a new skill, or simply listening to calming music.

We can’t change the fact that this pandemic has impacted the world. What we can change is the extent to which we inform ourselves and make choices that improve our wellbeing. Stay informed, calm, safe, and healthy and we hope to hear from you soon!

In light of the COVID-19 pandemic and recommendations for physical distancing by the CDC, we have created the option for virtual or electronic appointments for our patients. This may particularly be of interest for patients who are at high risk for contraction of the virus (people who are over the age of 60, have diabetes, are immunosuppressed, etc.)

If you would like to arrange a virtual appointment with any of our providers, please call our front desk. We will assess the need for labs and in-person visits on a case-by-case basis.

We wish you good mental and physical health during this difficult time. We are here to help you!