Diabetes

With over 20 years of experience in the field, Dr. Scumpia provides diagnosis, treatment, and management of all types of diabetes in an integrated clinic, including dietitian services, diabetes education, and insulin pump specialist. We conduct yearly evaluations for all diabetes-related complications. Dr. Scumpia is board-certified in diabetes and metabolism.

  • Diabetes includes two very different diseases: Type I (formerly known as juvenile diabetes) and Type II (formerly known as non-insulin dependent diabetes).
  • They are very different diseases and require different approaches to diagnosis and treatment.
  • Type I
    • Occurs most frequently in childhood
    • Involves autoimmune destruction of the pancreas with lack of insulin secretion, but it may also occur as a late-onset condition
    • These patients must always take insulin, and do best with insulin pumps
    • The incidence of complications is different compared to Type II
    • It should always be under the care of an endocrinologist
  • Type II
    • Also known as maturity-onset diabetes
    • Pre-diabetes occurs 10 to 20 years before diabetes, and the diagnosis of pre-diabetes with proper treatment may reduce your risk of future diabetes by 50 percent
    • By the time the diagnosis of diabetes is made, you have already lost 50 percent of the pancreas insulin secretion
    • Though associated with overweight/obese individuals, many patients are within the normal weight range
  • Complications:
    • Eye complications (retinopathy)
    • Cardiovascular complications (heart attacks, strokes, peripheral vascular disease and amputation)
    • Kidney complications (kidney failure and hemodialysis)
    • Neuropathy (numbness and tingling and inability to feel pain)
    • Patients with diabetes should have yearly eye checkups, neuropathy checkups, urine checkups, and formal cardiovascular risk assessment
  • Good control of diabetes requires keeping hemoglobin A1C less than 6.5, minimizing low blood sugars, aggressive cholesterol control (LDL less than 70 mg/dl), and yearly assessments for complications
  • All Type I diabetes patients should be under the care of an endocrinologist
  • All Type II diabetes patients should at least have a consultation with an endocrinologist for optimal care

Diabetes is a disease in which there is too much sugar in your blood. Of the 26 million Americans affected by it, 7 million do not know they have it. Our modern lifestyle of poor dietary habits and lack of physical activity puts many of us at risk.

Diabetes is caused either by the inability of the pancreas (a gland behind the stomach) to produce enough insulin, or by the body being unable to use the insulin effectively. Insulin helps transport sugar into the cells, where it is converted to the energy your body uses.

There are two types of diabetes: Type I and Type II. In Type I, the pancreas makes little or no insulin, and patients must take insulin daily. Type I diabetes occurs most often in children. It is known as juvenile diabetes, but can occur at any age.

In Type II diabetes, the most common form, the body cannot use the insulin properly, although it still produces some insulin. You may be at risk if you are overweight or have a family history of diabetes. Non-Caucasians and people older than 45 are at risk. A blood test can detect diabetes.

Another form of diabetes is gestational diabetes, which can occur during pregnancy. It often has no symptoms, and may require diet and insulin during pregnancy.

Symptoms and Complications

Diabetes can go unnoticed, and if untreated, causes major side effects. Common symptoms are: excessive thirst and urination, weight loss and constant hunger, vision changes, tingling of hands and feet, gum disease, and slow healing wounds.

Uncontrolled diabetes cause dangerous complications such as blindness, kidney failures, heart disease, stroke, nerve damage, and possible amputation of toes, feet, or legs.

Treatment and Prevention

Diabetes has no cure, hence prevention is best if you are at high risk. Focus on your health: be more active, do regular aerobic and strength training, or lose weight. Maintain a healthy diet by adding fiber (beans, nuts, seeds) to improve blood sugar control. Use smaller portions and smaller plates to lose weight.

If you have diabetes, there are many medications to treat it, both oral and injected.  Monitoring and controlling your blood sugar levels daily allow you to live a healthy, active life.

Medications

Metformin: facilitates insulin action to put sugar back into the cell.

Sulphonylureeas (Glucotrol, Glipizide, Diabeta, Amaryl, etc.): will act on the pancreas to produce more insulin. Due to concern of increased cardiovascular risk, these agents are less commonly used.

Pioglitazone: this agent increases the number of insulin-producing cells in the pancreas. However, it may produce swelling and increased weight gain.

DPP-4 inhibitors (Januvia, Onglyza, Tradjenta): these are new agents which improve symptoms without causing low blood sugar.

SGLT2 inhibitors (Invokana, Farxiga): reduce blood sugar by eliminating more sugar in urine.

Insulin: there are several forms, both long- and short-acting, each with its own indications. Examples include Novolog, Humalog, Lantus, Truejo, and other new medications.

Insulin pumps: the most sophisticated method of delivering insulin, and may be used for both Type I and Type II diabetes.

Both the American College of Endocrinology and the American Diabetes Association have issued recent new guidelines for the treatment of both types of diabetes. Today, we can combine several oral medications and insulin to provide ideal treatment.

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