Q&A

It could. Dark, thick, velvety-looking skin changes on the neck, armpits or groin are called acanthosis nigricans and are one of the outward signs of insulin resistance. In people without diabetes, it may point to a future risk of diabetes, but it can also have other causes. Especially if you are overweight, or have type 2 diabetes in the family or PCOS, don’t treat it as a cosmetic problem – the doctor will assess your fasting and after-meal blood sugar, insulin, HbA1c and HOMA-IR.

If he is conscious, sit him down or lay him down and immediately give him fast-acting sugar: 2 sugar cubes, a little honey, sugary water or sweet biscuits. Sugar substitutes don’t help in this situation. Once he feels better, give him porridge, a piece of bread or fruit. If he has lost consciousness, don’t put anything in his mouth, lay him on his side and call an ambulance immediately.

This is not recommended. After fructose, blood sugar rises more slowly than after regular sugar, so a person with diabetes notices the rise late and control becomes harder. Part of the fructose is turned into triglycerides in the liver and can lead to fatty liver, and by affecting leptin, the satiety hormone, it can also increase appetite. The best way to cut down on sugar is to give it up gradually.

It depends on the type of diabetes and your overall condition. Patients with type 2 diabetes can fast after their doctor has readjusted their medication doses, while fasting is generally not recommended in type 1 diabetes. The risk is also high for people on insulin, pregnant women, those whose sugar drops often, and those who don’t feel their sugar dropping. Make the decision together with your doctor before fasting, and don’t change the dose or timing of your medication on your own.

Without delay – as soon as you notice any wound or change on your foot. In diabetes, nerve damage reduces the sense of pain, wounds form easily and heal slowly, and infection develops more easily. A wound that has not healed for more than three weeks shows that diabetes is causing complications and definitely needs a doctor’s examination. Check your feet every day: early diagnosis and treatment can prevent amputation.

Yes. Diabetic retinopathy – damage to the retina – stays without symptoms for a long time, and in the early stage a person doesn’t notice their vision getting worse. That is why people with diabetes should have regular fundus examinations with dilated pupils. If you come in on time, the changes can be prevented. In addition, keeping blood sugar, cholesterol and blood pressure under control and quitting smoking protect the eyes.

Yes, you need to change the injection site. Injecting into the same spot can cause dents or hard lumps in the fatty tissue under the skin, as well as bruising, and blood sugar may go up and down. Each time, insert the needle at least 2 cm away from the previous injection site. Keep in mind that insulin is absorbed fastest from the abdomen and at a moderate rate from the thigh and upper arm – check the injection technique with your doctor.

It could, especially if it comes with other signs. A change in a child’s urination – wetting the bed again or getting up to the toilet often at night – can be the first signal of type 1 diabetes. If there is also heavy drinking, weight loss despite a bigger appetite, weakness and blurred vision, blood sugar should be checked. Finding ketones in the urine requires insulin treatment to be started immediately.

Yes, if your doctor has ordered it, you do. Gestational diabetes often causes no complaints at all, but if left uncontrolled it can lead to serious complications for mother and baby. The glucose tolerance test (OGTT) is the main way to detect it: fasting sugar is measured in the morning after at least 8 hours without food, 75 g of glucose is drunk, and sugar is checked again. During the test you must not eat, smoke or do physical work.

Not necessarily – it depends on the cause. A high TSH shows that the gland is underactive (hypothyroidism), but TSH can also rise temporarily, for example during an infection. In hypothyroidism caused by Hashimoto’s, if treatment is indicated, the medication is taken for life, while temporary thyroid problems may not need it. Don’t start medication on your own: the endocrinologist decides based on T3, T4, antibody and ultrasound results.

Yes, it does. Levothyroxine should be taken as soon as you wake up, on an empty stomach, with just a glass of water. Don’t eat, or drink tea or coffee, for at least 30–45 minutes after taking it. Don’t take calcium and iron supplements at the same time as your thyroid medication – they interfere with its absorption, and TSH may stay high even if the dose is increased. Take the medication at the same time every day, and only your doctor should change the dose.

No, this is a misconception. Weight gain is caused by the hormone deficiency itself, and often by an insufficient dose: in hypothyroidism the metabolism slows down, and even a person who eats little can put on weight. So don’t stop your medication out of fear of gaining weight. If your weight, tiredness or other complaints have changed, the doctor will look at your tests and assess whether the dose is right.

Not every Hashimoto’s patient needs medication. The decision is based not only on blood tests but on the ultrasound results and your complaints together. If TSH and T4 are normal and the gland’s function and structure are not yet affected, regular monitoring may be enough. Since Hashimoto’s is a lifelong condition, it is important to stay under an endocrinologist’s supervision even when TSH is normal.

It could – these signs are typical of an overactive thyroid gland (hyperthyroidism, popularly called “toxic goitre”). They may be accompanied by a fast heartbeat even at rest, heat intolerance, irritability and sleep problems. However, a diagnosis is not made on symptoms alone: a doctor’s examination, TSH, free T4 and free T3 tests, and a thyroid ultrasound are needed. Untreated hyperthyroidism seriously affects the heart, so don’t put off getting checked.

No, the popular belief that a goitre must never be touched has no scientific basis: a fine-needle procedure does not spread a nodule and does not cause cancer. Fine-needle aspiration (FNA) biopsy is performed under ultrasound guidance in sterile conditions, needs no anaesthesia, and the patient usually feels no pain. Being referred for a biopsy does not mean “you have cancer” – 90–95% of detected nodules are benign, and a biopsy is the most reliable way to be sure of that.

In some cases, yes. Not every nodule needs surgery: if a nodule causes no complaints and there is no suspicion of cancer, there is no need for an operation. For benign nodules that do cause complaints, one modern option is radiofrequency ablation (RFA) – a way of shrinking the nodule with a needle, without an incision. Which approach suits you is chosen after an ultrasound, hormone tests and, if needed, a biopsy.

No, don’t stop the medication on your own. The mother’s thyroid hormones play a key role in the development of the baby’s brain and nervous system, and untreated hypothyroidism increases the risk of miscarriage, preeclampsia and premature birth. If you have a thyroid condition, you should be under an endocrinologist’s supervision throughout the pregnancy – TSH and free T4 are usually checked every 4–6 weeks. Only the doctor makes any necessary change to the dose.

It could – these are typical signs of polycystic ovary syndrome. For a diagnosis, at least two of three criteria must be present: clinical signs, raised androgens in blood tests, and multiple small cysts in the ovaries on ultrasound. Most women with PCOS also have insulin resistance. If you are overweight, losing even 5–7% of your body weight can regulate your periods and increase your chances of pregnancy.

No, not every high result means a disease. Prolactin can also rise after sleep, stress, exercise, protein-rich food and touching the breasts, so the test should be taken after 8–14 hours of fasting, in the morning between 9:00 and 11:00, after sitting calmly for 20–30 minutes. If the result is high, macroprolactin is also checked. If a pituitary adenoma is suspected, the doctor orders an MRI; in most cases a prolactinoma is treated with medication, without surgery.

It can – stress is one of the most important causes of weight gain. Under stress, cortisol secretion increases, which makes you feel hungry often, and the fat cells around the abdomen are especially sensitive to this hormone. Chronic stress also disrupts sleep: hunger gets stronger and the feeling of fullness gets weaker. If complaints such as weight gain, high blood pressure and constant tiredness persist for a long time, have your adrenal hormones checked instead of taking vitamins on your own.

Some hair loss has endocrine causes, and in such cases shampoos and masks don’t solve the problem. The most commonly investigated causes are an underactive or overactive thyroid gland, iron deficiency (ferritin), vitamin B12 and zinc deficiency, and, in women, PCOS and excess testosterone. The doctor decides which tests are needed based on your complaints. Don’t take vitamins blindly: tests first, then targeted treatment.

It shouldn’t simply be accepted as “normal ageing”. After 40, testosterone levels naturally decline slowly, but a sharp drop can seriously harm men’s health. Persistent tiredness, reduced sex drive and muscle mass, and a lack of motivation can point to testosterone deficiency. For a diagnosis, total testosterone must be checked in the morning between 07:00 and 10:00; if a deficiency is confirmed, the doctor prescribes treatment.

Yes, densitometry, which measures bone density, is especially recommended for women going through menopause. Oestrogens affect bone strength, and the onset of menopause speeds up bone loss. Osteoporosis stays hidden for a long time: gradually getting shorter, back pain and fractures from minor injuries can be the first warning signs. For prevention, it is important to get enough calcium and protein, monitor your vitamin D level, stay active and cut down on salt.

They could. If your weight stays the same or increases despite diet and exercise, the cause may be hypothyroidism, insulin resistance, polycystic ovary syndrome, or cortisol or prolactin disorders. In such cases, the endocrinologist checks thyroid hormones, fasting and after-meal blood sugar, HbA1c, insulin and HOMA-IR, and, if needed, cortisol and prolactin. If a hormonal cause is found, it is treated first. Don’t use any hormonal injections without tests.

An endocrinologist deals with diseases of the hormone-producing glands: diabetes, thyroid diseases, obesity, osteoporosis, menopause, infertility, menstrual disorders, lipid metabolism disorders and hormone-related high blood pressure. If you suspect one of these problems, it makes sense to see an endocrinologist. If the first doctor you see finds an endocrine problem, they will also refer you to an endocrinologist.

The endocrinologist carries out a thorough examination and, if needed, orders certain tests and examinations such as an ultrasound. The decision is usually made not on a single number but by assessing tests, examination results and complaints together. Be sure to tell the doctor about all the medications you take, as some medications can affect hormone levels. If anyone in your family has had diabetes or thyroid disease, mention that too.

Yes, the fasting blood sugar test and the glucose tolerance test are taken on an empty stomach. In the glucose tolerance test, blood sugar is measured after 10–12 hours of fasting, then a 75 g glucose solution is drunk and sugar is checked again 2 hours later. During the test you must not eat, smoke or do physical work – otherwise the result is considered unreliable. Your doctor will decide which tests you need based on your complaints.

On the day of your test, give blood before taking your medication. For people on levothyroxine, it is important to repeat TSH, T3 and T4 tests every 3–6 months and, if needed, to monitor with ultrasound. Pregnancy, weight changes and other medications can affect the dose, while tiredness, hair loss or palpitations may show that the dose is not right. The doctor assesses the results, and only the doctor changes the dose.

A preventive check once a year is recommended for everyone over 40, and it is important for people in risk groups to have their blood sugar checked regularly. Risk groups include people who are overweight, lead a sedentary lifestyle, have diabetes in close relatives, have high blood pressure or cholesterol problems, and women who have had PCOS or gestational diabetes. Diabetes often progresses without symptoms for years, and in the early stage it is detected with simple blood tests.