Scripps Health - All News for Diabetes

How Small Steps Mean Big Success for Diabetes Management

2012-01-11T11:14:11-08:00

Scripps endocrinologist Dr. Matthew Levine knows that the key to helping his patients improve their health is by setting realistic goals. From the first consultation with someone who has Type 2 diabetes, he starts each patient off with a roadmap of baby steps toward a healthier future.

“I try to give them small things they can do immediately that will yield results,” he says. “Small wins can be very encouraging. The patient can see progress, which motivates them to take the next step.”

To encourage these small wins, Dr. Levine starts with an attainable weight loss goal. “If I can get patients to commit to losing 5 percent of their body weight and succeed — that’s great,” he says. “They see weight come off and blood sugar levels decrease. Some can reduce their medication.”

A 5-10 percent reduction of body weight can also lower a person’s risk for heart disease, hypertension (high blood pressure) and other adverse health conditions that go hand-in-hand with obesity. Studies indicate that that amount of weight loss may be enough to keep people with prediabetes from developing overt diabetes. That’s because slimming down makes the body better at using insulin and processing glucose — and so does working out.

In fact, The Diabetes Prevention Program — a large, federally-funded research study — found that people who followed a diet plan and exercised were able to prevent or delay Type 2 diabetes.

Getting started

The biggest obstacle for many people with diabetes is motivation. To get started on an exercise program, Dr. Levine encourages his patients to take daily 10-minute walks. If they are able to stick to that regimen, they can increase the duration. A bump to 30-minutes of exercise, five times per week is a great goal.

When it comes to making dietary changes, old habits can be hard to break. So Dr. Levine, again, focuses on setting realistic objectives. “Try reducing your starch servings to only one or two portions per day or reduce your fat intake to 30 grams per day,” he says. “The important thing is to make small, measurable changes that can be achieved.”

Dr. Levine says that people with diabetes initially have a lot of questions about managing the disease: they’re not sure how to make nutritional changes, how to start exercising, or how and when to check their blood sugar levels. They’re also somewhat fearful of taking medications. Doctors and clinical experts can help.

Scripps offers supervised programs in diabetes and weight management, which include elements of nutrition, exercise, medical management of disease, surgery and more.

“The important thing is to try to catch prediabetes and diabetes early,” says Dr. Levine. “The sooner you make positive lifestyle changes that result in weight loss, the better results you have managing diabetes, heart disease and a host of other health challenges.”

Find a doctor

If you have diabetes, lifestyle changes, such as modifications to diet and physical activity, are best when monitored by clinical professionals with special training. It’s important that care plans are tailored to each individual patient’s needs and overall health profile. If you are looking for a doctor who specializes in diabetes or weight management, visit the Doctor Finder or call 1-800-SCRIPPS (1-800-727-4777) to get a physician referral from a member of our call center.

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Clinical Trial Tests Insulin Pump to Manage Diabetes Better

2011-11-28T08:41:06-08:00

Diagnosed with Type 1 diabetes 35 years ago, Joan Reder is enrolled in the Star 3 Clinical Trial at Scripps Whittier Diabetes Institute. As part of the trial, she now has a digital insulin pump with a sensor to monitor her glucose levels. She used to take up to 7 insulin shots a day to manage her blood sugar. Today, that’s down to one every three days. Research like this is helping patients transform the way they manage their diabetes every day.

Learn more about how Scripps is transforming medicine.

Treating Diabetes With Bariatric Surgery

2011-11-08T14:41:39-08:00

Though clinicians often start with diet, exercise and lifestyle modification as a treatment course for people with diabetes, mounting evidence suggests that bariatric surgery can be a very effective intervention as well, especially for patients with Type 2 diabetes.

More than 30 years of outcomes suggests that gastric bypass surgery in particular can reduce or eliminate the health complications that come with diabetes. It also reduces health issues associated with diseases that often accompany morbid obesity, including:

Cardiovascular disease
Obstructive sleep apnea
Dyslipidemia
Hypertension

How does surgery reduce diabetic conditions?

“Weight loss surgery appears to set in motion certain chemical changes in the patient’s body that help set up better control of blood sugar levels,” explains Dr. William Fuller, bariatric surgeon with the Scripps Clinic Center for Weight Management in San Diego, California. He has performed more than 1,000 bariatric surgeries, with an emphasis on minimally invasive and laparoscopic approaches. “After the procedure, gut hormones involved in appetite and weight reduction are altered.”

About 30–40 percent of Dr. Fuller’s patients have diabetes. “We’ve seen blood sugar control start to improve in the weeks to months after surgery, even before large amounts of weight loss,” he says. “As a result, diabetes goes into remission or patients are able to scale back medications. There is often a positive change to the cardiovascular system and an extended lifespan.”

Who is a good candidate for weight loss surgery?

The National Institutes of Health guidelines state that weight loss surgery may be an option for patients who have:

A body mass index (BMI) of 40 or higher
A BMI of 35–40 with a serious weight-related health problem such as diabetes

As the prevalence of obesity and type 2 diabetes increases and more research emerges about the safety and effectiveness of bariatric surgery, criteria for selecting appropriate patients for weight loss procedures are evolving. In 2011, the FDA expanded the indication for gastric banding to include people with a BMI of 30–34, who also suffer from a severe obesity-related illness and who have tried other non-surgical options. Also, the International Diabetes Federation called for earlier consideration of weight loss surgery for some patients with the disease.

“All obese diabetic patients should be considered for surgery,” says Dr. Fuller. “We look at each patient’s individual appropriateness for it.”

As a surgeon who works within a multidisciplinary care team, Dr. Fuller and his colleagues carefully consult with each other to determine if surgery is right for a particular patient. Because having surgery to produce weight loss is a serious decision, risks and expectations are always discussed.

“Outcomes vary, so we want our patients to have reasonable expectations after surgery,” he says.

Post-surgical considerations

After surgery, Dr. Fuller and the care team continue to closely monitor patients. Due to his use of minimally invasive surgical procedures — which emphasize smaller incisions — wound healing doesn’t typically pose a more difficult challenge for diabetic patients. Perhaps the biggest concern is adjusting medication requirements after the procedure, to account for the body’s changing needs.

The importance of patient choice

In deciding whether or not surgery is a good option, Dr. Athena Philis-Tsimikas of the Scripps Whittier Diabetes Institute emphasizes patient choice. “It’s important that patients understand how limiting calories is essential to diabetes treatment, and that there is a full spectrum of options to achieve this.”

Any method that significantly reduces caloric intake, she says, can yield positive results.

“A patient that sticks to a monitored diet that is very low in calories can experience similar results to surgery,” she says.

Find a doctor

If you are looking for a doctor who specializes in diabetes management or bariatric surgery, visit the Doctor Finder or call 1-800-SCRIPPS (1-800-727-4777) to get a physician referral from a member of our call center.

Get a regular dose of health news and information from Scripps

Sign up to have health-related information from Scripps delivered to your inbox, including our monthly email newsletter. Designed to help you and your family get healthy and stay well, the publication contains timely and relevant consumer health news along with notices about classes, events and exclusive offers.

Are You at Risk for Diabetes?

2011-09-16T15:08:38-07:00

By Athena Philis-Tsimikas, MD

You’ve probably heard that diabetes has become an epidemic in the United States. According to the American Diabetes Association, 18.8 million adults and children have been diagnosed with the disease, and another 7.0 million are yet to be diagnosed.

Despite the rapidly increasing number of cases, however, diabetes is not a disease that happens overnight. Most cases of diabetes are type 2, which develops over time as a result of lifestyle factors such as obesity and lack of exercise. Type 2 diabetes often begins as a condition known as prediabetes, in which a person’s blood glucose levels are higher than normal, but not yet elevated enough to qualify as diabetes.

Prediabetes is estimated to affect 79 million people in the United States, although most don’t even know they have it. Though it often has no symptoms, it can do serious damage. Many people with prediabetes will develop health problems commonly associated with diabetes itself, such as an increased risk of cardiovascular disease. Moreover, prediabetes is likely to lead to type 2 diabetes within 10 years.

Since the condition has few if any symptoms, how do you know if you have it? A blood test that measures the level of glucose or sugar in your blood can give you an answer. There are several tests used for diagnosis. Two require fasting for at least eight hours before testing to ensure that you don’t consume anything that may affect the test results (eating or drinking may raise your blood glucose levels). The fasting plasma glucose test (FPG) measures your glucose levels first thing in the morning after you have fasted during the night. A fasting blood glucose level below 100 milligrams per deciliter (mg/dl) is considered normal; 100-126 mg/dl is considered “at risk” for diabetes.

The oral glucose tolerance test (OGTT) measures your blood glucose once after you have fasted. Then, you will be given a special high-glucose beverage to drink; two hours after you finish it, your blood glucose levels will be measured again. At this point, a blood glucose level below 140 mg/dl is normal.

Recently, a newer non-fasting test, HbA1C, has been used to measure how well your average blood glucose has been controlled over a period of two to three months. This test measures the percentage of glycated hemoglobin, or HbA1c, in your blood. A normal value is less than 5.7 percent; a value between 5.7-6.4 percent puts you in the “at-risk” category.

Who should be tested? If you are age 45 or older and overweight, it’s a good idea to have a prediabetes screening at your annual physical exam. Adults of any age who have other risk factors for diabetes or prediabetes, including a family history of diabetes, high blood pressure, low HDL cholesterol, high triglycerides, or a history of gestational diabetes should be tested as well. Ask your physician if testing is right for you.

Does being at-risk mean you are destined to develop diabetes? No. By taking steps to reduce your risk factors, such as losing excess weight and increasing exercise, you can lower your risk of developing full-blown diabetes. The recent Diabetes Prevention Program (DPP) study sponsored by the National Institutes of Health found that losing just 5 to 7 percent of body weight helped people who had a higher risk of diabetes delay or prevent the disease. This weight loss, along with 30 minutes of daily moderate physical activity such as walking, reduced the onset of diabetes by 58 percent. In fact, some patients have even seen their blood glucose levels return to normal levels as a result of this treatment.

Learn more about diabetes care at Scripps or call 1-800-SCRIPPS (1-800-727-4777) for a referral to a doctor.

Scripps Health Devotes $338 Million to Community Benefit Programs in 2010

2011-08-25T11:29:14-07:00

San Diego – Scripps Health devoted $338 million to local community benefit programs and services during fiscal year 2010, an increase of almost 9 percent over 2009 levels.

Scripps provides hospital services to one-quarter of the county’s uninsured patient population. Of this, Scripps Mercy Hospital’s San Diego and Chula Vista campuses provide 69 percent of the charity care within the Scripps system.

In addition to supporting the growing need to fund low- and no-cost health care services, Scripps invested in programs to train new physicians, provide health screenings for the underserved, offer wellness services for seniors, deliver care to the homeless and address other important community needs. The non-profit health system recently released its 2011 Community Benefit Plan and Report detailing its community benefit activities.

A copy of the report is available online at www.scripps.org/communitybenefit.

“We recognize that improving the community’s health happens both within and outside the physical walls of our health care facilities,” said Chris Van Gorder, president and CEO of Scripps Health. “Our community benefit programs show the Scripps mission in action through the efforts of our employees, physicians and volunteers, who provide the charity care and run the educational programs and health screening services our communities need.”

Uncompensated care represented the largest portion of Scripps’ community benefit contributions in 2010, totaling more than $286 million. Uncompensated care includes three elements: under-reimbursed care (under-payment from third-party payers, which accounted for $228.1 million; charity care (care for those who do not qualify for government payer programs and do not have commercial insurance, which totaled $43.4 million); and bad debt (failure to pay by patients whose health care has not been classified as charity care, which accounted for $14.7 million).

Scripps also invested $16.7 million in community health services to help improve the health of the community overall, including prevention and wellness programs such as screenings, health education, support groups and health fairs. Key activities included childhood obesity and diabetes prevention programs for underserved communities, reconstructive surgeries to children in need, cancer screenings and imaging services to low-income residents, health services to the homeless, and a health and wellness program for seniors.

Quality health care is highly dependent upon health education systems and medical research programs. Scripps invested $34.8 million in professional training programs and clinical research to enhance service delivery and treatment practices for San Diego County in fiscal year 2010. Each year, Scripps allocates resources to the advancement of health care services through graduate medical education, nursing resource development and other health care professional education.

Medical research plays an important role in improving the community’s overall health. In fiscal year 2010, $18.9 million went toward health research, and $13.3 million helped fund Scripps graduate medical education programs at Scripps Mercy Hospital’s San Diego and Chula Vista campuses, Scripps Clinic and Scripps Green Hospital.

In addition to the financial community benefit contributions made during fiscal year 2010, Scripps Health employees and affiliated physicians collectively volunteered more than 22,452 hours of their personal time to support Scripps-sponsored community benefit programs. This is equivalent to more than $955,000; which is reported separately from the Scripps FY10 community benefit programs and services total.

Scripps Health’s 2011 Community Benefit Plan & Report was developed in response to Senate Bill 697, passed in 1994, requiring the state’s community, private not-for-profit hospitals to document the full range of community benefits they provide on an annual basis. Scripps has taken this legislative requirement a step further by incorporating community benefit activities conducted from throughout the system, including Scripps’ five acute-care hospital campuses, home health care services, wellness centers and clinics. Scripps’ community benefit programs and services include activities that provide benefit to the community over and above the standard practices of care.

About Scripps Health

Founded in 1924 by philanthropist Ellen Browning Scripps, Scripps Health is a $2.3 billion nonprofit community health system based in San Diego, Calif. Scripps treats a half-million patients annually through the dedication of 2,500 affiliated physicians and 13,000 employees among its five acute-care hospital campuses, home health care services, and an ambulatory care network of physician offices and 23 outpatient centers and clinics.

Scripps is also at the forefront of clinical research, genomic medicine, wireless health and graduate medical education. With three highly respected graduate medical education programs, Scripps is a longstanding member of the Association of American Medical Colleges.

Could You Have Diabetes?

2011-08-08T13:52:36-07:00

Nearly 40 percent of Americans who have diabetes don’t know they have the disease. Could you be one of them? Should you be screened to find out?

Your blood glucose level could be high enough to put you at risk for diabetes, even if you don’t yet have any of symptoms of the disease, such as:

Excessive thirst
Frequent urination
Unexplained weight loss
Tingling in your hands, arms or feet

Your chance of developing the disease also increases if you have a family member (or members) with either type 1 or type 2 diabetes. Several other factors may put you at risk for type 2 diabetes, including:

Obesity
Sedentary lifestyle
Age (45+)
High cholesterol
High blood pressure
Personal history of gestational diabetes

If you do have diabetes, it’s important to find out sooner than later so you can manage your condition with medication, education, nutrition counseling, weight loss and exercise. People who ignore or don’t manage their diabetes are at risk of developing serious complications, from heart disease to blindness. The good news is you can actually delay or prevent Type 2 diabetes by making lifestyle changes.

Scripps offers diabetes management programs that can help.

Do you have risk factors for diabetes?

A simple blood test can determine if you have diabetes. If you have risk factors for the disease, talk to your doctor to see if you should be screened.

If you need a referral to a primary care physician, call 1-800-SCRIPPS (800-727-4777). For more information about diabetes care at Scripps, visit www.scripps.org/diabetes.

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Scripps Tips – August 2011

2011-08-11T15:55:47-07:00

Youth Football Season Set to Kick Off – Scripps Offers Game Plan to Reduce Overuse Injuries and Burnout at Free Aug. 25 Event
Youth football season kicks off in August – but some parents and coaches may commit unintended penalties by pushing their young athletes too hard, too soon. Overuse injuries and emotional stress are both on the rise in youth sports – often due to poor understanding of how kids develop their sports skills. “Better knowledge of this process is an important first step in reducing inappropriate training and unrealistic expectations,’” says Dr. Paul Stricker, a Scripps sports medicine pediatrician and former Olympic team physician. Dr. Stricker will lead a free educational seminar for parents and coaches Aug. 25 from 5:30 to 7 p.m. at Scripps La Jolla. To interview Dr. Stricker on this topic, please contact Steve Carpowich at 858-678-7183, or carpowich.stephen@scrippshealth.org.

Preventing Common Summertime Injuries
San Diego residents are among the most active in the United States and our location is ideal for outdoor activities. Each year, emergency rooms see patients with injuries that could have been prevented. Roneet Lev, MD, emergency room physician, has the scoop on how to prevent water and vehicle accidents, sunburns, heat illness, food poisoning and more. For more information, contact Kristin Reinhardt at 619- 686-3787 or reinhardt.kristin@scrippshealth.org

Monthly Calendar Items:

Diabetes Prevention
Tuesday, Aug. 30, 5 to 7 p.m.
Learn how to decrease your risk for diabetes from a certified diabetes educator. Learn the lifestyle behaviors that help prevent diabetes. Cost: $30. Presented by Scripps Whittier Diabetes Institute at Scripps Clinic Rancho San Diego.

Healthy Hearts
Sept. 7, 5:30 to 7 p.m.
Take a heart-smart approach to improving your health. Learn practical tips for nutrition, low-fat cooking, shopping and dining out. Free. Presented by Scripps Whittier Diabetes Institute at Scripps Coastal Vista, Cedar.

Multiple Sclerosis: Fall Lecture Series
Sept. 13 or Oct. 4, 6:30 to 8:30 p.m.
Join neurologist Charles Smith, MD, for a series of seminars that offer valuable information for people wanting to better manage their MS symptoms and improve quality of life. Free. Location: Scripps La Jolla Hospital, Schaetzel Center, Great Hall.

Science and Art of Meditation and Spiritual Practice
Aug. 22, 12:30 p.m.
Join Karen Sothers, MEd, to learn the scientific basis for meditation and spiritual practices while experiencing effective, efficient methods for increasing ease, happiness and kindness in daily life. Cost $15. Location: Scripps Center for Integrative Medicine in La Jolla.

Meal Planning for Diabetes
Sept. 13, 6 to 7:30 p.m.
Learn the truth about carbohydrates and how to eat to manage diabetes or pre-diabetes. Classes are taught by a registered dietitian. Free. Location: Scripps La Jolla Hospital, Schaetzel Center, Walker Room.

Summer 2011 Health and Wellness Classes

2011-06-27T15:27:41-07:00

See our quarterly Health Connections calendar for a list of health-related classes, screenings and events.

Events range from support groups to general health seminars to special training. Topics include:

Heart healthy nutrition and lifestyle
Driving safety
Pelvic floor conditions
Diabetes prevention
Health care reform, and what it means for you
CPR classes
Weight management and nutrition
Parenting

For more information, or to sign up for a class, call 1-800-SCRIPPS (1-800-727-4777).

You can also visit our online classes and screenings listing to search for classes, and register online.

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The Savvy Patient - Manage Diabetes with Lifestyle and Medication

2011-05-17T12:21:24-07:00

In this week’s installment of The San Diego Union-Tribune’s “Savvy Patient” column, Scripps Health provides insight on managing diabetes.

Many of the potential complications of chronic disease, such as diabetes, can be prevented with a combination of knowledge, lifestyle changes and medications.

Approximately 26 million adults and children in the United States have Type 1 or Type 2 diabetes. An additional 79 million have pre-diabetes, meaning their blood glucose levels are higher than normal but not yet high enough for a diabetes diagnosis.

Prevention of diabetes complications starts with controlling the risk factors. Aim to achieve and maintain a healthy weight and get physically fit through diet and exercise. Strong, healthy hearts and bodies are the best defense against complications.

Read the full article for more: Manage diabetes with lifestyle and medication

Scripps Tips – May 2011

2011-05-09T16:48:43-07:00

Despite Effectiveness of Immunizations, More than One-Third of Kids Now ‘Under-Vaccinated’ – Scripps Expert Can Separate Myth from Reality
The prevalence of diseases that are preventable by vaccines has dropped since the widespread introduction of immunizations. But a recent study shows that more than one in three children today may be “under-vaccinated” during the first two years of their lives, putting them at increased risk for contagious diseases like measles and whooping cough. Some parents are concerned about the safety of vaccines, especially combination vaccines that protect children against several diseases with one shot. However, the American Association of Pediatrics and others agree that vaccines are not the cause of autism or ADHD. Dr. Sivathilaka Ganesh is available to help distinguish myth from reality when it comes to childhood immunizations. To arrange an interview, please contact Steve Carpowich at carpowich.stephen@scrippshealth.org or 858-678-7183.

Grocery Shopping Made Easier for People with Diabetes
Following a diabetes meal plan can seem challenging when you’re at the grocery store faced with hundreds of shelves full of choices, each carrying its own confusing food label. A registered dietician and diabetes peer educator from the Scripps Whittier Diabetes Institute is available to provide tips and guidelines about nutrition, serving sizes and healthy meals so people with diabetes can make the best food selections. To arrange an interview, please contact Rachel Lichterman at 858-678-7348 or lichterman.rachel@scrippshealth.org.

Understanding Prediabetes
Prediabetes affects an estimated 57 million people in the United States. Most people with prediabetes experience no symptoms, but there are a few signs that could indicate you’re at risk. Prediabetes is a condition that can morph into Type 2 diabetes. It is defined as a sustained elevation in blood sugar, which deprives the body’s other cells of fuel and is harmful to the circulatory system. Health experts at the Scripps Whittier Diabetes Institute in La Jolla are able to discuss these key signs, talk more about the disease and offer prevention tips. To arrange an interview, please contact Rachel Lichterman at 858-678-7348, or lichterman.rachel@scrippshealth.org.

Understanding Perimenopause
Perimenopause and hormones can affect mood, energy, sleep, sex drive, bone health and hair loss, with many women experiencing symptoms in their 40s or even late 30s. Sudabeh Moein, MD, is available to discuss safe and effective hormone therapy options for managing these changes, as well as a host of alternative therapies. Please contact Kristin Reinhardt at 619-686-3787 or reinhardt.kristin@scrippshealth.org for more information or to set up an interview on this topic.

Learn to Manage Symptoms of Menopause with Integrative Medicine;
Free Seminar Set for May 19
Women understand that changing hormone levels can create havoc in life, causing hot flashes, moodiness, headaches, insomnia and weight gain. All could be symptoms of early menopause (perimenopause) or menopause, which can begin as early as a woman’s late 30s. During the seminar, Dr. Raneth Heng of Scripps Center for Integrative Medicine will reveal how factors like genetics, stress, surgery and medications can influence a woman’s transition into perimenopause and menopause. She also will provide tips about optimizing health during the stages of menopause by using an integrative medicine approach such as acupuncture, herbs, bio-identical hormones and other pharmacological remedies. To arrange an interview with Dr. Heng, please contact Rachel Lichterman at lichterman.rachel@scrippshealth.org or 858-678-7348.