Type 1 Diabetes occurs when there is absence of insulin in the body. The disease presents suddenly, usually after a minor illness. Here the only treatment is insulin. Patients and their families need extensive education on how to inject insulin, check blood sugars, diet and so on. A normal life is possible including pursuing a career and having children.

This is the common form of diabetes. There is insufficient insulin in the body and insufficient action. There are Five targets to manage this condition :

1. Ideal body weight
2. Normal blood pressure
3. Normal cholesterol
4. Normal blood glucose
5. No tobacco use

These five targets are achieved by 5 methods :

1. Diet
2. Exercise
3. Medications (oral and injectable)
4. Monitoring : Regular check ups
5. Education : diabetes self management education

Hypothyroidism occurs when the thyroid gland is unable to produce adequate levels of thyroid hormone. The condition is treated by thyroid hormone replacement. The dose of thyroid hormone tablets needs to be carefully regulated. There are no side effects as we are merely replacing a deficit.

An overactive thyroid gland causes symptoms like weight loss tremor or palpitations. Some patients get better on their own and need to be identified early on. Treatment for the rest is with tablets, radioiodine or surgery. Eventually all patients will become hypothyroid.

Obesity or being overweight is a common problem and over eating is the commonest cause. Treatment is often frustrating as major and permanent life style changes have to be made and these are often not acceptable.

Hirsutism is where women have thick, dark hair on their face, neck, chest, tummy, lower back, buttocks or thighs. It results from excess male hormones, and mostly occurs with multiple cystic changes in ovaries known as polycystic ovary syndrome.

Here the ovary does not produce female hormone and does not produce mature eggs. The defect can lie in the ovary or in the pituitary. Mostly managed by administering female hormones.

Here the testis does not produce male hormone and does not produce mature sperms. The defect can lie in the testis or in the pituitary. Mostly managed by administering male hormones.

It is quite simple to replace the male hormone but getting the testis to produce sperm is a complex and challenging task.

Gender incongruence is a situation where the person feels uncomfortable in the gender in which he or she has been born. This is no longer considered a mental health issue. Treatment is complex and needs to be delivered by a multidisciplinary team.

Here bones become brittle . Osteoporotic bones can easily break under very little stress, of a kind that which would not affect normal bones. It commonly occurs after menopause but can affect both sexes. All women should check bone health 5 years after menopause.