Dr. Digman Talks About Diabetes
Colleen R. Digman, MD, is a specialist in adult diabetes at North Shore Medical Center
At what point do people with diabetes need to see a specialist (known as an endocrinologist?)
A patient should first talk with his or her primary care doctor, who will often make a referral to an endocrinologist. I encourage people with diabetes to see an endocrinologist early on, especially if there are complications.
How do endocrinologists help people with diabetes control their blood sugars?
First, I want my patients to know how diabetes develops and how it may evolve over time, and that includes the potential need for insulin for those patients with Type 2 diabetes. Also, because diabetes care takes a team approach, I want them to see a dietitian and a nurse, and to participate in a diabetes education program. Changing life habits, such as exercise, is a very high priority, and I discuss that at each visit. I review what the targets of therapy are in regards to a patient's blood sugar, blood pressure, and cholesterol. I definitely want my patients to be a partner in their own care.
For people who are using glucose meters, how often should they check their blood sugars and what are the goals?
For people whose blood sugars are managed with oral medications, I recommend checking blood sugars at least twice a day, each morning and 2 hours after each meal. For people who are on insulin, I recommend checking blood sugars at least 4 times a day; more often than that if they use an insulin pump. My aim is get their blood sugars within or close to normal range without causing hypoglycemia. In general, this can mean a fasting range of 80 to 120 milligrams per deciliter (mg/dL) and a 2 hour after meal blood sugar ideally less than 140, but up to 180 mg/dL is considered to be within the target. Of course, no two people are alike, so I individualize these goals for elderly patients, for example, or for those who do not recognize signs of low blood sugar.
Do people who have Type 2 diabetes ever need insulin?
Absolutely! Type 2 diabetes is a complicated disease and insulin is often needed to manage it. (Often there are misconceptions about this because insulin is thought to be used only in Type 1 diabetes, previously referred to as juvenile diabetes or insulin dependent diabetes.)
It is difficult to predict from the time of the diagnosis who may or may not require insulin in the future, as many factors are taken into consideration. I explain to my patients that over time, a combination of worsening insulin resistance and decreased insulin production is often seen. In cases such as this, a patient may be on maximum oral agents and their blood sugars are high — in the 200’s to 300’s —and when that happens I initiate insulin. Insulin therapy may need to be initiated much earlier than this, though. For newly diagnosed Type 2 diabetics with hyperglycemia associated with symptoms (increased thirst, urination, blurred vision), I will initiate insulin and potentially transition them to oral medications at a later date. For patients with chronic medical problems such as COPD, heart failure, renal failure, and liver disease, the use of oral agents may be limited due to the concern for safety, and in these patients, I prefer to use insulin.
--By Jean Bianchetto, MS, RD, LDN
Diabetes is a disease in which the body does not produce or properly use insulin. Insulin is a hormone that is needed to convert sugar, starches and other food into energy needed for daily life. The cause of diabetes continues to be a mystery, although both genetics and environmental factors such as obesity and lack of exercise appear to play roles. There are 20.8 million children and adults in the United States, or 7% of the population, who have diabetes. While an estimated 14.6 million have been diagnosed with diabetes, unfortunately, 6.2 million people (or nearly one-third) are unaware that they have the disease. Major types of diabetes include:
Type 1 diabetes
Results from the body's failure to produce insulin, the hormone that "unlocks" the cells of the body, allowing glucose to enter and fuel them. It is estimated that 5-10% of Americans who are diagnosed with diabetes have type 1 diabetes.
Type 2 diabetes
Results from insulin resistance (a condition in which the body fails to properly use insulin), combined with relative insulin deficiency. Most Americans who are diagnosed with diabetes have type 2 diabetes.
Gestational diabetes
Gestational diabetes affects about 4% of all pregnant women - about 135,000 cases in the United States each year.
Pre-diabetes
Pre-diabetes is a condition that occurs when a person's blood glucose levels are higher than normal but not high enough for a diagnosis of type 2 diabetes. There are 54 million Americans who have pre-diabetes, in addition to the 20.8 million with diabetes.
--adapted from the American Diabetes Association web site
