Endocrinologists at NSMC evaluate and treat disorders of the endocrine system, including the treatment of diabetes. The Chief of Endocrinology at NSMC provides answers to common questions patients have about diabetes in the interview below. Go here to learn more about our comprehensive Diabetes Management Program .
Interview with
Paul Copeland, MD, Chief of Endocrinology
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. A referral to an endocrinologist can then be made, as needed.
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 educator, and to participate in a diabetes education program. Changing life habits, such as food choices and exercise, is a very high priority, and I discuss ways to accomplish these changes. I review the targets of therapy 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?People should check blood sugars as often as the information is useful to guide treatment. For example, a person with Type 2 diabetes who is only taking a medication that has a low risk of hypoglycemia (too low blood sugar) may only need to check blood sugars about 2 hours after some meals to see if the meal raised the blood sugar above goal (it should be less than 180 mg/dl and, ideally, less than 140). They may also check an occasional morning blood sugar before breakfast to see if they are in the desirable range of 80-120 (although the normal range for people without diabetes is 70-100). People who are taking medications that can cause hypoglycemia will need more frequent blood sugar checks at additional times. Also, those who are instructed to adjust their oral medications, or especially their insulin, will need more frequent blood sugar monitoring.
Do people who have Type 2 diabetes ever need insulin? Insulin is often needed to manage type 2 diabetes and almost all patients eventually will need insulin.
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 useful medications other than insulin and their blood sugars are still too high. That is when I am likely to initiate insulin. At times, insulin therapy may be needed much earlier than this.
For some newly diagnosed patients with type 2 diabetes who may have 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 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 may prefer to use insulin.
Do insulin injections hurt?Modern needles are so thin that the insertion is virtually painless. When I demonstrate the use of insulin syringes at lectures for health providers, I sometimes have to look to be sure the needle really is in. (Fingerstick blood sugars are much more discomforting.)
--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
