Diabetes

Diabetes is one of the most common chronic conditions seen in both adults and children. It is characterised by insufficient insulin in the body leading to high blood sugar or glucose levels. 

There are two main types of diabetes. 

Type 1 diabetes is a lifelong condition which is thought to be caused by autoimmune disease that prevents the pancreas from producing insulin. 

Type 2 diabetes is far more common than type 1 diabetes and usually occurs later in life. This is a condition where the body does not produce enough insulin.  

The other type of diabetes is called gestational diabetes, and this develops during pregnancy in some women. It usually goes away after giving birth.

Pre-diabetes is when the sugar levels are above the normal range but not high enough to be called diabetes. This should not be taken lightly as it increases the risk of developing type 2 diabetes. This can be managed with lifestyle changes such as losing weight, regular exercise, and avoiding excess carbohydrates or sugars. 

It should be noted that it is very important to get an early diagnosis of diabetes to prevent long-term complications associated with untreated diabetes. 

The symptoms of type 1 and type 2 diabetes are similar, but type 1 diabetes can develop very quickly over days or weeks, whereas type 2 diabetes usually develops over years. 

The common symptoms of diabetes are increased thirst, urinary frequency, weight loss, feeling tired, frequent episodes of vaginal thrush, and blurred vision. Weight loss is common in type 1 diabetes rather than type 2. 

People with type 2 diabetes may not show any symptoms for years and high sugar levels may be noticed during a routine blood test. 

Type 1 diabetes is not preventable through lifestyle changes, but type 2 diabetes can be prevented with healthy eating, losing excess weight and regular exercise. 

The risk of type 2 diabetes is higher with obesity or being overweight, high blood pressure, sedentary lifestyle, family history of type 2 diabetes, and certain medications such as long-term steroids. 

Gestational diabetes also increases the risk of developing type 2 diabetes. 

The treatment of type 1 diabetes is insulin which needs to be taken for life. 

Mild type 2 diabetes can be managed with healthy lifestyle changes. People who are unable to manage their type 2 diabetes with lifestyle changes will require treatment with tablets or injections. 

Diabetes is a complex disease, and it requires multidisciplinary input from different healthcare professionals. 

People with diabetes should have regular follow up with their usual doctor and diabetes nurse. It is strongly recommended to get regular eye screening as diabetes can cause an eye disease called diabetic retinopathy. This condition occurs over time and can lead to sight loss if it is not treated. 

Diabetes can have an impact on the nerves in the feet leading to loss of sensation. It can also reduce the blood supply to the feet. These issues can cause problems with normal feeling in the feet and difficulties with healing if injured. This can lead to the formation of diabetic ulcers and infections. People with diabetes should have their feet assessed every year. 

If there are symptoms that may suggest diabetes, it is strongly recommended to see a doctor in person for full assessment and early diagnosis. Early diagnosis will allow appropriate treatment to be initiated as soon as possible to prevent diabetes-related complications. 

Dizziness is a common symptom that some people experience. It is not usually a serious problem if there are no other associated symptoms.

People may use different terms to describe how they feel. 

Dizziness is a general term used to describe a sensation of spinning or disorientation. 

Light headedness is a feeling of faintness or about to pass out. This is often linked to dehydration or low blood pressure. 

Feeling off-balance means a sensation of unsteadiness or difficulty maintaining stability. This may be related to inner ear issues or neurological problems. 

Vertigo is a specific type of dizziness where a person feels as though they or their surroundings are spinning or moving. This is usually related to inner ear problems.

If dizziness occurs when standing or sitting up suddenly in the absence of other symptoms, this is likely to be due to sudden drop in blood pressure. This is known as postural hypotension. 

Symptoms of feeling off-balance, losing some hearing, ringing or tinnitus in the ears usually suggest inner ear disorder. Further assessment would be required to find the underlying cause. 

Feeling off-balance, nausea or vomiting after a cold or flu is likely to be due to labyrinthitis. This is a type of inner ear infection that affects the balance. This should improve as the cold and flu resolve within 1 to 2 weeks.

The rarer causes of dizziness are migraine, stress, anxiety, heat exhaustion, low blood sugar or hypoglycaemia, iron deficiency anaemia or motion sickness.  

Dizziness usually resolves on its own without needing any treatment. 

It is advisable to lie down until the dizziness passes, and to get up and move slowly and carefully to prevent falling and causing injuries.  

It is recommended to drink plenty of fluids, and to avoid coffee, smoking, alcohol and drugs. 

It is advised to see a doctor if the dizziness does not resolve or keeps coming back, there are difficulties with hearing and speaking, there is ringing or tinnitus in the ears, or if there is visual disturbance such as double or blurred vision. 

Dry skin occurs when the skin loses water more quickly than usual leading to dehydrated skin. 

The most common causes of dry skin are increasing age, seasonal variations, certain medical conditions like eczema and contact dermatitis, and various skin products.  

Dry skin can also be caused by central heating or other heaters, having frequent baths or showers, using soaps on the skin, washing products, hard water, or cold, windy weather. 

Dry skin can feel rough or tight and can lead to discomfort, itching, cracking or flaking.  

If someone has eczema and dry skin, this can be aggravated by pollen, pet fur, house dust mites, detergents, biological washing powders, or allergies to certain foods. 

Dry skin usually gets better quite quickly, but it can last longer in people with eczema or contact dermatitis. 

Dry skin can be treated with various emollients. Emollient is a medical term for moisturiser. Emollients come in the form of creams, ointments and lotions. 

An emollient can be used to moisturise the skin, reduce itching and inflammation, and help skin to work better as a barrier to irritants and infections. 

Ointments are usually more effective at moisturising dry skin. Creams and lotions are cooling, and work better for inflamed skin. 

As ointments can be greasier than creams, some people may prefer to use them at night, and to use creams and lotions during the day. 

The general advice is: 

- to use an emollient as often as needed and this can be every 2 to 3 hours if the skin is very dry

- to use plenty of emollient each time

- to use a clean spoon to remove the emollient if it is in a pot without pump dispenser, to prevent bacteria from fingers entering the emollient

- to use the emollient just after washing once the skin has been pat dried and still moist

- to apply the emollient in the direction of the hairs on the skin to avoid blocking the hair follicles 

- to not share the emollient with other people.

If one emollient does not work or cause skin irritation or stinging, a different emollient can be tried until the best one is found.

If the skin is inflamed, a topical steroid like hydrocortisone cream or ointment can be considered. Steroid cream or ointment should be put on the skin about 15 to 30 minutes after using the emollient. It should be used for 48 hours after the inflammation is better. 

Steroid creams should not be used for more than 7 days at a time as prolonged use can thin the skin. 

To prevent dry skin from getting worse or coming back, it is important to use plenty of emollient each time and keep using it after the skin has improved, to drink plenty of water to prevent dehydration, and to shower after swimming to wash away the chlorine.

It is advisable to avoid using soap or bubble baths, to avoid frequent baths or showers and to use warm instead of hot water, to avoid wearing woollen or rough clothes, and to avoid spending a lot of time in air-conditioned places. 

It is recommended to see a doctor for further assessment if the dry skin does not get any better after 14 days of using an emollient, or if there is a high temperature, crusts on the skin or pus leaking out, or very inflamed or swollen skin. 

Earache or ear pain is a common symptom, and it is not usually a sign of anything serious. Earache is more common in children due to childhood infections. It usually resolves within 7 days without requiring treatment. 

Young children may not be able to communicate their symptoms well and they might indicate earache by rubbing or pulling their ears, not responding to some sounds, having high temperature, and being irritable and off their food. 

There are several causes of earache, and one of the most common causes is ear infections, particularly in children. Treatment is not always required for ear infections as they are caused by viruses, and they often get better on their own within 3 to 5 days. 

Ear infections can present with an earache, a high temperature, hearing loss, discharge from the affected ear, or feeling of pressure inside the ear. 

Ear infections that do not resolve on their own within 5 days may be treated with antibiotic tablets or eardrops, or antifungal or steroid eardrops. 

The other common cause of earache is sore throat or tonsillitis which is infection of the tonsils. Sore throat or tonsillitis is usually caused by viral infections, and they usually resolve on their own within 7 to 10 days. 

Paracetamol can be considered if there is significant pain. Warm drinks with lemon and honey can also soothe the pain. 

More severe cases are treated with a course of oral antibiotics. 

Glue ear in children is a common cause of earache. Glue ear occurs when the middle part of the ear canal is filled up with fluid due to recurrent ear infections or allergies. This usually clears up within 3 months. 

The common symptoms are earache, temporary hearing loss, ringing or tinnitus in ears, and balance problems. 

Although it is less common, adults can also get glue ear and present with similar symptoms.

Treatment is not always required for glue ear. More severe or recurrent cases may require a specialist assessment to consider insertion of grommets or small tubes implanted in the ear, or rarely surgery to remove the adenoids at the back of the nose. 

A benign and common cause of earache is build-up of earwax in one or both ears. Earwax usually falls out of ears on its own, but sometimes it can cause ear pain, hearing loss, tinnitus or dizziness.  

This can be treated with olive oil from a pharmacy or various eardrops designed to remove earwax. More resistant cases may require microsuction procedure to suck the wax out. 

It should be noted that teething in children and dental abscess in adults can also cause ear pain. 

There are several measures that can be taken to help with earache. Placing a warm or cold flannel on the ear can help reduce the earache. For more severe pain in ears, a painkiller like paracetamol can be considered. 

It is not recommended to put cotton buds or anything similar inside the ears, to try to remove the earwax, or to use water jet inside the ears. 

It is advisable to see a doctor for further assessment if there are symptoms such as discharge or bleeding from the ears, hearing loss, swelling around the ears, high temperature, feeling of something stuck in the ear, history of injury, if earache lasts more than 3 days, or if feeling unwell with earache. 

Eczema is an inflammatory skin condition that makes the skin itchy, dry and cracked. There can be scaly or thickened patches, red, crusty areas, blisters and skin infections. 

Eczema is also called atopic dermatitis. It is most common in young children, but it can affect people of all ages. The symptoms usually start in babies and young children and tend to get better as they grow older.

Eczema can affect different parts of the body, but it appears more commonly on the elbows, knees and hands. In babies and toddlers, it is also common on the face. 

The exact cause of eczema is not fully understood. Eczema often happens in people who have allergies, and it can be related to asthma and hay fever. It can also run in families. 

Certain things can make eczema worse or cause flare-ups. These include allergens and irritants like soap and washing detergent, pets, pollen, house dust mites, some fabrics, and certain foods. Stress, temperature changes, skin infections, and hormonal changes can also aggravate eczema. 

It should be noted that eczema is not contagious so it cannot be spread or caught from someone else. 

There is currently no cure for eczema, but the symptoms can be managed well with various treatments and measures. The treatments for eczema consist of emollients, topical steroids, and antihistamines. 

Emollient is a medical term for moisturiser, and it can come in the form of cream, ointment and lotion. 

For common and uncomplicated eczema, topical emollients can be applied to the affected areas. Aveeno, Oilatum, Epiderm or E45 Eczema Relief are among commonly used options.  

A topical steroid medication like hydrocortisone cream, lotion or gel can be used to treat eczema. Steroid cream should not be used for more than 7 days at a time as it can thin the skin, unless this has been recommended by a doctor. 

An antihistamine such as chlorphenamine, loratadine or cetirizine may also be beneficial to help with the symptoms of eczema, particularly if there is itching or irritation. 

For more severe eczema, there are other treatments such as tacrolimus ointment, pimecrolimus cream, or special dressings.  

There are some things that can be done to help manage the symptoms of eczema. It is advisable to avoid allergens and irritants that make eczema worse, to apply emollients frequently, to wash with an emollient instead of soap, and to keep the skin cool. 

The emollient can be used up to four times a day during flare ups. It can be used when the skin feels dry, and at nappy change in babies. Emollient should be applied in the direction of hair growth and not rubbed in. 

Emollient can be continued during and after steroid treatment. 

A weak dose of hydrocortisone cream once daily may be considered for eczema on the eyelids and periorbital area which is the area around the eyes. 

Oral steroids for more severe cases or flare-ups of eczema can be prescribed by a doctor for a very short term. 

For recurrent infected eczema, chlorhexidine containing emollients, and bleach baths once or twice a week can help. 

Specialised treatments of eczema are available, and these include ciclosporin, azathioprine, mycophenolate, and methotrexate. 

There are also newer treatments for eczema, and these are JAK inhibitors, and biologic dupilumab. 

It should be noted that these treatments can only be prescribed by a dermatology specialist and only if the conventional treatments do not work. 

If conventional treatments and measures fail to control eczema, it is recommended to see a doctor or dermatologist for further assessment. 

If eczema is blistered, crusty, leaking fluid or pus, if the skin is painful and swollen, if it suddenly gets worse, or if there is high temperature, it is also advisable to see a doctor in person as these can indicate that eczema is infected. 

Contact dermatitis is a type of eczema characterised by inflammation of the skin that occurs when it comes into contact with an irritant or allergen. This can affect any part of the body but most commonly involves the hands and face. 

Contact dermatitis can be classified into two types called irritant contact dermatitis and allergic contact dermatitis. 

Irritant contact dermatitis is caused by substances like harsh soaps, chemicals, or cleaning agents that directly irritate or damage the outer layer of the skin. It can lead to redness, dryness, and cracking of the skin that comes into contact with these substances. 

Allergic contact dermatitis is less common and occurs when the skin reacts to an allergen, such as nickel, certain plants like poison ivy, or fragrances. It causes redness, itching, and sometimes blisters.

Some people may also get allergic contact dermatitis from handling row, uncooked fruit and vegetables. 

Symptoms of both types include itching, redness, swelling, and sometimes blisters or dry, cracked skin. 

The reaction or symptoms usually occur within a few hours or days of exposure to an irritant or allergen. 

Contact dermatitis usually resolves completely if the irritants and allergens causing the inflammation are avoided. The most crucial step is identifying and avoiding the substance that caused the reaction in the first place, whether it is an irritant or an allergen. 

If this is not sufficient, there are treatments that can be considered. Treatment typically involves using topical steroids and moisturising the skin.

Over-the-counter or prescription corticosteroid creams or ointments like hydrocortisone help reduce inflammation and itching. For more severe cases or if contact dermatitis covers a large area of the skin, stronger topical steroids or oral steroids may be prescribed by a doctor.

Moisturisers applied to the skin can help stop it becoming dry or cracked. Keeping the skin hydrated helps repair the skin barrier and reduce dryness. Fragrance-free moisturisers should be used to avoid further irritation.

Oral antihistamines like loratadine or cetirizine can help control itching and irritation. 

Applying cool, wet compresses to the affected area can soothe irritation and help reduce inflammation.

Calamine lotion or oatmeal baths may also help soothe itching and discomfort associated with contact dermatitis.

If there is secondary infection, such as from scratching, topical or oral antibiotics may be required. 

For severe, chronic cases, drugs like tacrolimus or pimecrolimus may be considered.

For persistent cases, phototherapy or ultraviolet light treatment may help control inflammation.

If contact with irritants or allergens cannot be avoided, steps can be taken to reduce the risk of these causing symptoms.

If there has been contact with an irritant or allergen, it is recommended to rinse the affected skin with warm water and an emollient as soon as possible. 

Gloves can be used to protect the hands, but these should be removed every now and again as sweating can make any symptoms worse. 

Applying emollients frequently and in large amounts can keep the skin hydrated and help protect it from allergens and irritants. 

It is advisable to see a doctor for further assessment if these measures do not work or if there is a persistent rash, as there may be other underlying causes.

1. Normal skin pH is slightly acidic, which helps maintain the skin barrier and fight microbes.

People with eczema often have a higher or more alkaline skin pH, which allows bacteria like Staphylococcus aureus to flourish and worsen inflammation.

Emerging treatments aim to restore skin acidity, such as acidic creams or pH-balancing cleansers.

2. Research suggests a link between gut microbiome imbalance and eczema flares.

Some small studies show that probiotics may help prevent eczema in infants or reduce severity.

Trials are ongoing to see if faecal microbiota transplants could benefit severe, treatment-resistant cases.

3. Biological treatment called Dupilumab has revolutionised treatment for moderate-to-severe eczema.

Pipeline biologics aim to reduce itch, inflammation, and flares with fewer side effects than steroids or immunosuppressants.

4. Many eczema patients have a mutation in the filaggrin gene, which weakens the skin barrier.

This mutation also increases the risk of food allergies and asthma later on in life, a concept known as the atopic march.

New gene therapies and barrier-repair molecules are being developed to compensate for this genetic weakness.

5. Beyond itching, eczema is linked to sleep disruption, which in turn increases anxiety and depression risk.

Brain imaging studies suggest that chronic itch activates the same brain centers as chronic pain, which explains the emotional burden.

Future treatments may focus on this aspect of eczema. 

Endometriosis is a condition where tissue which is similar to the lining of the uterus appears in other places outside the uterus. This condition can affect women of any age who have periods.  

The exact cause of endometriosis is not fully known. It is thought to be associated with hormones, and it can present from puberty to menopause. 

Endometrial tissue is mainly found in the abdominal region around the ovaries and fallopian tubes, but it can affect bowels, bladder, diaphragm, and respiratory tract. 

Endometriosis causes pain as the patches of it break down and bleed during menstruation but cannot leave the body as in a normal period. 

The common symptoms are severe period pain, heavy periods, pain on urination and bowel movement, lower abdominal or back pain, pain during or after sexual intercourse, and extreme tiredness. 

Endometriosis can also cause low mood, anxiety and fertility issues. 

Period-related urinary symptoms such as pain on urination and blood in the urine could be due to endometriosis. 

Painful bowel movements or dyschezia during periods can be due to endometriosis. 

The gold standard diagnostic test is laparoscopy which involves looking inside the abdominal cavity directly via a camera. An ultrasound scan can be considered first to rule out other causes of pain. 

There is currently no cure for endometriosis, but there are treatments that can help with the symptoms. Painkillers such as paracetamol, ibuprofen and codeine can alleviate the pain. 

If these do not work, other medications such as amitriptyline or gabapentin can be considered. 

Hormonal treatments can suppress endometriosis and relieve symptoms. Combined oral contraceptive pill, desogestrel pill, oral or injectable medroxyprogesterone, or Mirena coil, or Zoladex (goserelin) can be considered. 

Combined pill can be taken as an extended pill-taking regime with only 4-day break. This could work but is an unlicenced method. It can be taken continuously to avoid any bleeding. 

The last resort is surgery where the endometriosis tissue is removed if conventional treatments do not work. 

Laparoscopic hysterectomy is the recommended choice of surgery for severe cases of endometriosis, and it involves removing the uterus. 

If the ovaries are removed due to endometriosis or as part of hysterectomy, treatment with HRT may be required until at least the age of 50 to reduce any unwanted symptoms. 

Not every gynaecologist is an expert in endometriosis, and therefore, it is best to see a gynaecologist that specialises in endometriosis.

Fungal nail infections usually affect toenails, but the infection can sometimes grow on fingernails. 

The infection causes brittle, discoloured and thicker looking nails. Although the infection itself is not serious it can look unsightly and can take a long time to treat fully. 

There are various over the counter medications that can be used to treat fungal nail infections. These treatments usually contain amorolfine, terbinafine or itraconazole. 

The medicine is brushed on the affected nails, and it should be used daily or weekly, depending on the type.  

As fungal nail infections can take a long time to clear the treatment may need to be continued for 6 to 12 months. And it can take several months before an improvement is seen. It is therefore advised to persevere with the treatment and the affected nails should be filed down to help clear the infection.

If conventional over the counter treatments do not work, it is best to see a doctor in person for further assessment and treatment. 

Sometimes a sample from the affected nails can be taken to confirm the diagnosis or to determine the exact type of infection. 

Oral antifungal medication can be considered for resistant cases of fungal nail infections. These medications are not suitable for people who have liver or kidney disease. 

Very severely infected or deformed nails may need to be removed surgically under local anaesthetic. 

Fungal nail infections can be prevented with a few simple measures. The nails should be kept short and the feet clean and dry. It is recommended to wear clean socks every day, to wear flip-flops in showers at the gym or pool, to wear well fitting shoes, and to treat athlete’s foot promptly before it spreads to the nails. 

It is best to avoid sharing nail clippers or scissors and towels, and to avoid other people’s shoes or those that cause hot and sweaty feet.