[Hypothyroidism substitution and adrenal insufficiency in diabetic patients]

As diabetes mellitus type 1 is part of the polyglandular autoimmune syndrome it is no wonder that autoimmune disorders of the thyroid are in diabetics about five times more common and adrenal insufficiency four times more common than in general population. Manifest hypothyroidism leads to the decrease in insulin sensitivity and increase of glucose stimulated insulin secretion. These changes are reversible by substitution. Even subclinical hypothyroidism increases demand on pancreatic beta cell. The glucocorticoid insufficiency causes marked increase of insulin sensitivity, decrease of endogenous glucose production and increase of glucose oxidation. Synthetic thyroxin is optimal for thyroid hormones substitution. Combined substitution with trijodthyronin did not proved to have any beneficial effect. The basis of substitution in adrenal insufficiency is replacement of hydrocortisone in doses that do not have negative metabolic effects. Preparations available today do not allow imitating the nature diurnal rhythm but slow-release tablets are being tested. Androgen substitution is not routinely recommended.