Diabetes Services

We work with patients to customize an insulin regimen that will control their blood glucose values while avoiding low blood glucose reactions. Insulin pumps and continuous glucose monitoring systems are used when they will benefit the patient and will fit into their lifestyle. The goal of diabetes management is to achieve a healthy life by avoiding the long-term complications of diabetes (blindness, kidney failure, nerve damage and premature cardiovascular disease.)

In type 1 diabetes, the body makes little or no insulin—called insulin deficiency. People with this type of diabetes must take insulin injections to live. That’s why you sometimes hear it referred to as “insulin-dependent diabetes.” Up to 1 in 10 people with diabetes have type 1. Although it usually begins when people are young, onset may occur at any age.

Type 1 diabetes is usually diagnosed in children and young adults, and was previously known as juvenile diabetes. However, it can develop at any age throughout adulthood. Generally, people with type 1 diabetes are diagnosed when symptoms appear suddenly or they experience extremely high blood sugar (glucose) levels.

The preferred test for diagnosing type 1 diabetes is the fasting plasma glucose (FPG) test. This blood test requires fasting (no food or drink except water) for at least 8 hours and is usually done in the morning.

Other tests used to diagnose diabetes are the casual plasma glucose test (a blood test taken at any time of day without regard to time since last meal), the oral glucose tolerance test (OGTT: a blood test taken 2 hours after drinking glucose dissolved in water), and the glycated hemoglobin (A1C). A person recently diagnosed with type 1 diabetes may not have an elevated A1C. This test is not often used when type 1 diabetes is suspected.

A diagnosis of diabetes is made if a person has any of the following test results:
FPG is 126 mg/dL or higher
High blood sugar (hyperglycemia) symptoms exist and casual plasma glucose is 200 mg/dL or higher
Plasma glucose is 200 mg/dL or higher at 2 hours during an OGTT
A1C is greater than or equal to 6.5%

If any of these test results occur, testing should be repeated on a different day to confirm the diagnosis.

Treatment of Type 1 Diabetes in Children

People with type 1 diabetes must take insulin shots to live because their bodies cannot produce insulin. The goal of type 1 diabetes treatment is to maintain blood sugar (glucose) levels as near to normal as safely possible. Blood sugar goals are different for different age groups and change as children grow into adulthood.

Good nutrition, careful monitoring of carbohydrate and fat intake, and regular physical activity are also important to manage type 1 diabetes and preventing long-term complications.

Children and Diabetes

When your child has diabetes, it affects the entire family. Keeping up with the latest information and tools to care for a child with diabetes is a vital role for parents. Not only are there frequent advances in diabetes care, but the needs of children with diabetes can change as they get older. Managing diabetes at any age requires skill and attention.

Today, diabetes can be managed effectively, allowing kids to stay healthier and live active lives. But you and your child can’t manage diabetes alone. You’ve got to have a team of healthcare professionals that can work with you. Your child’s team may include a doctor (pediatrician, endocrinologist, family physician, internist, or nurse practitioner), a diabetes educator, a dietitian, and other specialists. It’s important that you and your child are comfortable with those people that are part of the team, their level of experience in diabetes, and their approach to its treatment. Ask questions, and make sure to get answers you can understand.

Healthy Eating for Children with Diabetes

Your child’s eating habits are an important part of managing diabetes. This may require changes of habits and healthier eating for them and could also benefit you and the rest of your family. Creating a meal plan is a critical part of diabetes care. Four separate things have to be coordinated—what and how much your child eats, when they eat, how active they are, and their insulin schedule. Ideally, these all work together to help keep the blood sugar (glucose) level within the target range.

While it sounds complicated, it can be a relief knowing that no “special” foods are required. Rather, it will be important to learn how to match the amount of foods eaten (especially carbohydrates) with the amount of insulin taken. The ideal meal for a child with diabetes isn’t different than the kind of healthy meals recommended for all of us. A dietitian can help you create a meal plan that your child can enjoy.

For all children with diabetes, it’s necessary to balance food intake, activity levels, and medications to maintain a healthy blood sugar level. Monitoring blood sugar levels is important to understanding how these three things interact.

Keeping Records

Recordkeeping (link to patient information) is essential to managing your child’s diabetes. This helps you understand if your child’s treatment plan is keeping blood sugar levels within the target range. It also allows you to keep track of what happens to your child’s blood sugar on a daily basis and during those important events like the championship baseball game or pizza Wednesdays at school.

At School or Daycare

Another common issue is diabetes management in school or daycare settings. It’s important that caregivers know how to check your child’s blood sugar and administer insulin or an injectable treatment for severe low blood sugar (hypoglycemia) in an emergency. There are several resources available to help parents develop a diabetes management plan with school or daycare personnel.

Getting Support

You’ve already begun the process of managing your child’s diabetes. While it may seem like an overwhelming amount to learn right now, in time you’ll find it can become second nature. Watching your child grow and take on more responsibility for their own care will be challenging but also gratifying.

It’s important to remember you’re not alone. You’ve got family, friends, and an entire team of healthcare providers supporting you. Ask for help when you need it and don’t forget to take care of yourself.

Proper meal planning, physical activity, oral medications, and insulin are each used as needed to develop an individual treatment plan that will eliminate elevated blood glucose values while avoiding low blood glucose reactions. The goal of diabetes management is to achieve a healthy life by avoiding the long-term complications of diabetes (blindness, kidney failure, nerve damage and premature cardiovascular disease).

In type 2 diabetes, your body may still make insulin, but is unable to effectively use the insulin it does make (insulin resistance). Eventually the body doesn’t make enough insulin (insulin deficiency). Type 2 used to be called “non-insulin dependent diabetes.” People who have it can be treated with proper meal planning, physical activity, and may require medications. Type 2 diabetes is the most common form of diabetes and accounts for 90%-95% of cases. Although it can occur in younger people, people over 45 years of age are at higher risk.

Some people are more prone to diabetes.

The tendency to develop type 2 diabetes is inherited (present at birth)
It does not always come from being too heavy
It is not caused by eating too much sugar.

Causes of type 2 diabetes

No one knows the exact cause of type 2 diabetes. We do know that it is more likely to occur in people who have certain risk factors, such as older age, obesity, family history of type 2 diabetes, and certain race/ethnicity (African American, Hispanic/Latino American, American Indian, Asian American, or Pacific Islander).

Symptoms and Diagnosis of Type 2 Diabetes

In its early stages, type 2 diabetes often has no symptoms. When symptoms do occur, they may come on gradually and be very subtle. They may include:

increased hunger and thirst
numbness or tingling in hands or feet
blurred vision
frequent gum, skin, or bladder infections
slow healing of cuts or sores
feeling tired
frequent infections
increased urination

In the U.S., type 2 diabetes is frequently not diagnosed until many years after it begins, when complications appear. Approximately one-fourth of all people with diabetes may be undiagnosed. The American Diabetes Association recommends that people age 45 and above be tested for diabetes at least every 3 years. Adults who are overweight or obese and who have one or more additional risk factors for diabetes should also be tested at least every 3 years, regardless of age.

The preferred test for diagnosing type 2 diabetes is the fasting plasma glucose (FPG) test.1 This blood test requires fasting (no food or drink except water) for at least 8 hours and is usually done in the morning.

Other tests for diabetes are the casual plasma glucose test (a blood test taken at any time of day without regard to time since last meal), the oral glucose tolerance test (OGTT: a blood test taken at 2 hours after drinking glucose dissolved in water), and the glycated hemoglobin (A1C).

A diagnosis of diabetes is made if a person has any of the following test results:

FPG is 126 mg/dL or higher
High blood sugar (hyperglycemia) symptoms exist and casual plasma glucose is 200 mg/dL or higher
Plasma glucose is 200 mg/dL or higher at 2 hours during an OGTT
A1C is greater than or equal to 6.5%.

If any of these test results occur, testing should be repeated on a different day to confirm the diagnosis.

What is Prediabetes?

Before people develop type 2 diabetes, they almost always have “prediabetes”—blood sugar (glucose) levels that are higher than normal but not yet high enough to be diagnosed as diabetes. As of 2010, there were at least 79 million people in the United States aged 20 years or older with pre-diabetes. A diagnosis of pre-diabetes is made using the FPG test, the OGTT, or the A1C. Depending on which test is used, pre-diabetes is categorized as:

Impaired fasting glucose (IFG): FPG is 100 mg/dL to 125 mg/dL
Impaired glucose tolerance (IGT): plasma glucose is 140 mg/dL to 199 mg/dL at 2 hours during an OGTT
A1C: 5.7% to 6.4%

Recent research has shown that some long-term damage to the body, especially the heart and circulatory system, may already be occurring during pre-diabetes. Research has also shown that if you take action to manage your blood sugar when you have pre-diabetes, you may be able to delay the onset of type 2 diabetes. Much of the same advice for good nutrition and physical activity that is given to patients who have diabetes can benefit people with prediabetes.

Treatment of Type 2 Diabetes

Although diabetes cannot be cured, it can be managed by various treatments including the use of diabetes medications. These include several types of oral and injectable medications and the various types of insulin. While most people with type 2 diabetes take either diabetes pills, insulin or both, a few can manage their blood sugar with careful meal planning and regular physical activity.

Diabetes is different for each person. Depending on the stage of your diabetes and your body’s response to certain therapies, your doctor may prescribe one or more treatments. For example, you may be able to manage your diabetes with diet and exercise alone, or with the addition of a single diabetes pill or more than one diabetes pill. Some people may use pills plus an injectable product like insulin or a glucagon-like peptide-1 (GLP-1) receptor agonist. For others, it may make more sense to start with insulin injections instead of pills. It’s common for your therapy to change from time to time, depending on the stage of your diabetes. Your blood sugar readings will help you and your doctor identify whether there is a need to change your treatment plan.

Meal planning and exercise are important parts of diabetes management, regardless of the type of medicine used. Always talk with us before beginning an exercise program or making significant changes to your diet.

Oral medications

Many people with type 2 diabetes are able to take diabetes pills to manage their blood sugar. These pills are not insulin. Oral medications work in different ways to lower blood sugar. Some pills help your body use the insulin it makes, and some pills help your body make more insulin. In order for diabetes pills to work, your body must be able to make insulin. This is why diabetes pills cannot be used to treat type 1 diabetes.

Glucagon-like peptide-1 (GLP-1) receptor agonists (injectable) A GLP-1 receptor agonist is a unique kind of drug for the treatment of type 2 diabetes. It “mimics” many of the actions of a naturally occurring hormone from the intestines and can help the body make more of its own insulin. The most common side effects include nausea and vomiting. Low blood sugar (hypoglycemia) can occur when used with a sulfonylurea. Pancreatitis, which can be life threatening, and, allergic reactions, which may be serious, can occur.

Insulin (injectable) There are several types of insulin products available to replace the insulin the body can’t make. Most people use more than one type of insulin to more closely mimic the way the body’s own insulin would act. Low blood sugar is a possible side effect of all insulins.

Gestational diabetes is a type of diabetes that starts, or is first discovered, during pregnancy. It occurs when the body cannot keep up with the increased demand for insulin that is brought on by diabetes. Often this can be treated by changing your diet. Sometimes oral medications or insulin may be required. After delivery, we will monitor your glucose values to see if the gestational diabetes has resolved or has changed into permanent diabetes.

Diabetes can be the cause of miscarriages and birth defects. However, with proper management, the rate of miscarriage and birth defects can be the same as in women without diabetes. The best outcomes for mothers and their babies are achieved when glucose is controlled prior to conception and then is maintained in a desirable range throughout the pregnancy. We have more than twenty years of experience with successfully managing pregnancy in diabetes.

Insulin pumps offer some distinct advantages when attempting to precisely control blood glucose levels. The ability to use several different basal rates, to take fractions of units of insulin, to stop or decrease the insulin infusion, or to use custom delivery methods all may contribute to better glucose control. We have been working with insulin pump patients since 1995 and we have a full-time certified insulin pump trainer on our staff.

Continuous Glucose monitoring reports a blood glucose value every 5 minutes throughout the day—that’s 288 blood glucose values per day. Using this technology greatly assists people with diabetes to understand how insulin works in their body. The monitor shows the response to food insulin boluses and physical activity. The system also has alarms to indicate when the blood glucose is raising or falling to unacceptable levels. Finally, it gives an indication of the rate at which the glucose is rising or falling. This technology may be used daily or on an intermittent basis as needed.