Diabetes affects more than 20 million Americans. Over 40 million Americans have pre-diabetes.
Patients with diabetes have too much sugar in their blood (hyperglycemia). Controlling blood sugar helps prevent serious problems that can be caused by diabetes.
Insulin is a hormone produced by the pancreas to control blood sugar. People with diabetes have high blood sugar because their pancreas does not make enough insulin, their muscle, fat and liver cells do not respond to insulin normally, or both.
Complications of diabetes can include problems with the eyes, kidneys and nerves, which can lead to blindness, dialysis or in some cases, amputation.
Our comprehensive diabetes program involves new diagnostic tools, treatment methods and aggressive clinical approaches to achieve optimal glucose control. We attempt to reduce risk factors in family members and try to prevent pre-diabetes progressing into diabetes as well as reverse complications of diabetes.
We treat all aspects of diabetes:
- Type 1 and Type 2 diabetes
- Drug-induced and other causes of diabetes
- Hypoglycemia (low blood sugar)
- Hyperglycemia (high blood sugar)
Diabetes services and treatments we provide:
- Diabetes nutrition counselling
- New classes of oral medications for diabetes
- GLP-1 analogue injections (Byetta®, Bydureon®, Victoza®) for type 2 diabetes
- Multiple daily injections of short and/or long-acting insulin
- Insulin pens
- Insulin pumps
- Inhaled insulin
- Real-time continuous glucose monitoring
- Symlin® injections for glucose control
- Diabetes education and supportive care
- Screening for diabetes complications
- Intensive diabetes management during pregnancy
- Online submission of blood glucose logs by patients
- Weight management
- Exercise and activity recommendations
- Diabetes education by certified diabetes educator
- Identification and reversal of risk factors in family members
- Preventing progression of prediabetes to diabetes
- Insulin Pump Therapy
What is insulin pump therapy?
- An insulin pump is a cell phone-sized device clipped to your belt, slipped into a pocket, or hidden under your clothes. It delivers exact doses of rapid-acting insulin to closely match your needs:
- Basal rate: small amount of insulin delivered continuously
- Bolus dose: to match your food and correct for high sugars. “On-demand” bolus calculators are included.
How does the insulin get into your body?
- A tiny cannula is inserted under your skin to deliver insulin
- Flexible tubing delivers insulin from the pump reservoir to the infusion set
- Insulin enters your bloodstream
Benefits of insulin pump therapy
- More flexibility with eating choices, timing and activities
- Replaces multiple daily injections
- Tighter control, especially important before and during pregnancy
- Better predictability
- Targets Dawn phenomenon (high blood sugars in the early morning)
- Matches the pattern of insulin release in delayed digestion (gastoparesis)
- Targeted adjustments to reduce hypoglycemia (low blood sugars)
Are you a candidate for insulin pump therapy?
Discuss with your endocrinologist whether you are a candidate for an insulin pump. It is helpful to compare the available insulin pumps on the market to decide which is the best for you.
More information at Medtronic
Other insulin pumps:
- Continuous Glucose Monitoring
Fingersticks are the most widely used method of self-monitoring glucose in diabetes. Fingersticks give you a snapshot of your blood sugar at one moment. CGM offers the advantages of real time, around the clock monitoring. Unique features include:
- Up and down trends and rates of change in blood glucose level
- Alert setting for lows and highs including while you are sleeping
- Allows you to correlate how food, physical activity, medication, and illness impact your diabetes
How Does CGM Work?
A small glucose sensor electrode is inserted under the skin to measure glucose levels in tissue fluid rather than from your blood in a fingerstick.
It is connected to a wireless transmitter that sends the information to a monitoring and display device.
The device can alert you if your glucose is reaching a high or low limit. Some devices can communicate with an insulin pump to suspend insulin delivery if the sugar reaches a low threshhold.
Do you still need to perform fingersticks if you have a CGM?
Yes. Fingersticks may be needed 3–4 times per day for optimal glucose sensor accuracy. To calibrate the CGM you need at least one fingerstick every 12 hours.
Are you a candidate for CGM?
CGM is indicated for type 1 and type 2 diabetes under the following situations:
- If you have frequent episodes of unexpected high or low blood sugars
- If you are not able to reach your A1C goals and would like more feedback about your day to day glucose patterns
- If you are pregnant with gestational diabetes, or if you are diabetic and thinking about planning your pregnancy
More information at:
What is diabesity?
Diabetes and obesity have shared metabolic and inflammatory factors. Dr. Francine Kaufman coined the term diabesity (diabetes + obesity). It affects more than one billion people worldwide, including 100 million Americans. Diabesity affects 50% of Americans over 65. Diabesity has the following common features:
- abdominal obesity (i.e. “spare tire” syndrome)
- abnormal cholesterols (low HDL, high LDL and high triglycerides)
- high blood pressure
- high blood sugar (fasting sugar above 100 mg/dL, Hb1Ac above 5.6)
- systemic inflammation
- a tendency to form blood clots
The rapid increase in the prevalence of obesity, type 2 diabetes and associated complications (diabesity) is a major problem in Europe as well. DIABESITY is a European Union Framework involving a consortium of 27 partners from 24 European Institutions, coordinated by The University of Gothenburg, Sweden.
In her book Diabesity: The Obesity-Diabetes Epidemic That Threatens America—And What We Must Do to Stop It, Dr. Kaufman explains the roots of diabesity quite simply: "Our ancient genes and our modern environment have collided." Our bodies store excess calories as fat. In ancient times calories were hard to come by. Today, fast food and junk food are everywhere. Coupled with our increasingly inactive lifestyle, the result is obesity."
Diabesity Related Conditions
- PCOS (polycystic ovary syndrome)
- Gestational diabetes
- Metabolic syndrome
- Type 2 diabetes
- Diabetes Education
We offer the most comprehensive diabetes education right here in our office based on National Diabetic Education Guidelines. From frequent blood sugar testing to counting carbohydrates, to getting the right amount and type of exercise, it is important that people with diabetes understand the roles each segment of their treatment and management play. Drs. Anita and Jyoti Bhat and our highly knowledgeable certified diabetic educators will guide you.
Specific education will be tailored around using an insulin pump and/or continuous glucose monitoring.