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Comprehensive Diabetes Management

Diabetes is a condition in which the body is unable to regulate levels of glucose (sugar) in the blood. This occurs when the body does not produce or correctly use insulin, a hormone that lowers glucose levels. Diabetes is a condition that demands proper treatment and management. There are various different types of diabetes, here we will discuss the few common ones.

For more information please visit: www.diabetes.org.

Type 1 Diabetes

Type 1 diabetes mellitus is a chronic medical condition that occurs when the pancreas, an organ in the abdomen, produces very little or no insulin. Insulin is a hormone that helps the body to absorb and use glucose and other nutrients from food, store fat, and build up protein. Without insulin, blood glucose (sugar) levels become higher than normal.

Type 1 diabetes requires regular blood sugar monitoring and treatment with insulin. Treatment, lifestyle adjustments, and self-care can control blood sugar levels and minimize the risk of disease-related complications. Type 1 diabetes usually develops when the immune system destroys the insulin-producing cells (called the beta cells) in the pancreas. This is called an autoimmune response. The cause of this abnormal immune response is not clearly known and is being studied. This requires the patients to check finger stick blood sugar several times per day, give insulin shots or use an insulin pump. Management of Diabetes also requires one to have good understanding of diet and watch for carbohydrates and see your doctor on a regular basis.

Type 2 Diabetes

Type 2 diabetes is often but not always associated with obesity and high blood pressure. Type 2 diabetes is a result of resistance to the effects of insulin. Successful diet and exercise plan are key to living healthy with type 2 diabetes. Treatment may also include medication and or Insulin.

Note: If type 1 or type 2 diabetes remains untreated or ignored it can prove fatal. It is very important to have your diabetes under a very tight control to prevent long term serious complications.


Pre-diabetes patients suffer from blood glucose levels that are higher than normal but not yet high enough to be diagnosed as type 2 diabetes. Over 57 million Americans currently have pre-diabetes, and it is absolutely imperative that all pre-diabetes patients seek medical assistance. Untreated diabetes increases the risk of kidney failure, blindness, cardiovascular disease, stroke and death.

Gestational Diabetes

Gestational diabetes occurs during pregnancy, generally starting at around 28 weeks or later. Women who have gestational diabetes are at higher risk to develop diabetes in later life. It is very important to have a good control of diabetes during pregnancy to have safe outcomes of pregnancy and a healthy baby. We coordinate care with the sweet success program which primarily deals with diabetes in pregnancy.

Diabetes Related Complications

Diabetes increases the risk for many serious complications. Correct treatment and recommended lifestyle changes can help prevent or delay the onset of complications. It is important to keep blood sugar near-normal to reduce your risk of long-term complications including but not limited to cardiovascular disease, which can cause heart attack, chest pain, stroke, and even death. There are various other complications which your physician will discuss at the time of your visit.

This risk of complications could be lowered by not smoking, taking a low-dose aspirin every day if advised by your physician, keeping the blood pressure and cholesterol controlled and keeping your A1C under 7 percent or lower. It is important to tightly control blood sugar levels before and during pregnancy to minimize the risk of complications.

The following links are excellent diabetes resources:

Diabetes Education Program

Marshall Medical Center (MMC)-Diabetes and Nutrition Education Program

We work very closely with the Diabetes and Nutrition education program at Marshall Medical Center. It is an American Diabetes Association (ADA) Recognized Program which means that the program meets the 10 National Standards for Diabetes Self-Management Education (DSME) and its services are covered by Medicare.

The Registered Dieticians and Registered Nurse -Certified Diabetes Educators and will meet with you individually to develop a tailored approach to your medical condition, which is based upon your individual needs and preferences. Successful lifestyle changes can best be achieved and maintained with ongoing coaching and support. Group educational classes are offered on a regular basis including daytime and evening classes. Most insurance plans cover the services offered. A physician referral is required. If you are an established patient with Capitol Endocrinology, you may call our front desk for a referral.

For more information on the MMC Diabetes & Nutrition Education program or to make an appointment, please call (530) 672-7021. Visit the Marshall web site at www.marshallmedical.org for additional information on all of the Marshall services available.

Insulin Pump

An Insulin pump is a medical device that helps deliver small amounts of rapid-acting insulin continuously throughout the day using a small flexible plastic catheter that sits gently under the skin. Insulin pumps can help manage diabetes with more flexibility and freedom instead of taking multiple daily injections. These could be used in patients with both type 1 and type 2 diabetes mellitus. It helps keeping blood glucose levels steady between meals and during sleep with a basal rate. Bolus Insulin can be given to cover the meals to deliver the amount of insulin needed to match the grams of carbohydrate in the food and for the Glycemic correction. There are many different kinds of insulin pumps that are available and our staff could help you decide which pump will best meet your needs.

For Medtronic customers if you have any technical assistance please call the 24 hour helpline at (800) 646-4633 option 1 and additionally our Medtronic representative is Michelle Barnett and is always happy to support you as well. Important Reminders for All Pumpers:

Hyperglycemia protocol- BGs greater than 250 mg/dl take a bolus with your pump and recheck in one hour. If the BG is not responding take a correction bolus (use the Bolus Wizard calculations for your own personal dose) with a syringe and change your infusion site. If consistent high BGs continue please call our office and or go to the nearest hospital.

Hypoglycemia protocol- BGs less than 70 mg/dl eat 15 grams of rapid acting carbohydrates and wait 15 minutes and recheck. If a low BG persists repeat 15 gram treatment until stabilized. If consistent lows are occurring please call us for support.

For more information please check the following links:

Continuous Clucose Monitoring (CGMS)

There are various different kinds of CGMS devices available at this time and we carry some of them to help manage your diabetes to the next higher level. CGMS is a medical device that measures the glucose content of interstitial fluid using an electrochemical enzymatic sensor. Interstitial fluid is accessed by a needle sensor inserted subcutaneously devices extract interstitial fluid across the skin. Real-time continuous glucose monitoring systems (CGMS) have the potential to improve glycemic control while decreasing the incidence of hypoglycemia.

This device is designed to capture your glucose controls continuously 24 hours a day. Your physician prescribes this to be continuously worn for 4 days- 1 week while continuing to manage your diabetes. It allows your health care provider to review your glucose patterns and trends. While wearing the CGMS, you will still need to check your fingerstick blood glucose to calibrate the system.

CGMS can be very valuable in patients with hypoglycemic unawareness who are at risk for or have severe hypoglycemia. This also helps controlling daily fluctuations in blood glucose and detecting the frequency of unrecognized hypoglycemia. There are newer devices that provide real time results of glucose values on a continuous basis.

Once your physician determines you to be an appropriate candidate for CGMS then the receptionist will call you based upon the availability to make 3 appointments made for you. Initial start up / insertion date, Return / take off date and a follow up visit to discuss the findings with your physician. Expectations and preparation for the CGM start up meeting:

  • Allow approximately 30 minutes for the procedure
  • Wear easy clothing for easy access to the sensor insertion site
  • Bring your meter, strips and lancet device to the appointment
  • Before the appointment, eat a "typical" meal as opposed to a large amount of food

While the monitor is worn, it will be essential to measure at least four or more blood sugars per day. You will also be keeping a detail record of food intake, insulin dosages and daily activities using a patient Log Sheet

The days on monitor should represent typical days. If you become ill or have any factors affecting your blood sugar such as cortisone medication, please call as early as possible to reschedule your appointment. Please wear the CGMS until you return on your scheduled return date.

For more information please check the following links:

Thyroid Disorders

Thyroid gland is a small and butterfly-shaped gland, located just below your Adam's apple. This gland is responsible for producing hormones that affect your body's metabolism and energy level. The three most common thyroid disorders are: an underactive thyroid, an overactive thyroid, and thyroid nodules. An underactive thyroid, termed as Hypothyroidism, is caused by a decreased or total lack of production of thyroid hormones. Hypothyroidism slows down important chemical processes within the body and metabolism. Symptoms include weight gain, fatigue and depression to name a few. In turn, an overactive thyroid, Hyperthyroidism, is caused by an increased production in thyroid hormones. The quickening of the body's metabolism results in the following symptoms: nervousness, anxiety and Palpitations to name a few. Lastly, thyroid nodules are lumps located in the thyroid gland. In rare cases they cause thyroid cancer, but most often they are benign. More common in women than men, thyroid disorders are detected in both cases via a medical history, blood tests, and in some case a chest x-ray.

For more information please check the following links:


The term "goiter" refers to the abnormal enlargement of the thyroid gland. Thyroid gland could be functioning normal or abnormal in this setting and does not necessarily mean that the thyroid gland is malfunctioning.

For more information please check the following links:

Thyroid Nodules

The term thyroid nodule refers to any abnormal growth of thyroid cells into a lump within the thyroid. Majority of thyroid nodules are benign (noncancerous), a small proportion of thyroid nodules do contain thyroid cancer. Because of this possibility, the evaluation of a thyroid nodule is aimed at discovering a potential thyroid cancer. Some Thyroid nodules could be over functioning by producing too much of Thyroid hormones. There are long term complications of overproducing thyroid nodules if not addressed earlier on. For more information please check the following links:

Thyroid Cancer

Thyroid cancer is the most common endocrine-related cancer. In the United States there are about 20,000 new patients annually. The outlook for patients with thyroid cancer is usually excellent if diagnosed and evaluated on time. Most thyroid cancer is easily curable with surgery and they rarely cause pain or disability. Effective and well-tolerated treatment is available for the most common forms of thyroid cancer.

For more information please check the following links:

Adrenal Gland Disorders

The adrenal glands are the triangular shaped endocrine glands located on top of the kidneys. They are primarily responsible for releasing essential hormones such as cortisol and adrenaline. When the adrenal glands don't work properly, problems can arise in the form of Adrenal insufficiency, Cushing's syndrome, and Congenital Adrenal Hyperplasia. Evaluation and testing for adrenal disorders is quite complicated and treatment differs from one adrenal gland disorder to the next. In some cases medication is needed, in others surgery, microsurgery or radiation therapy. Our physicians always work to find the absolute best solution on a case by case basis.

For more information on Adrenal Gland Disorders please visit www.Hormone.org

Metabolic Bone Disease & Osteoporosis

Osteoporosis is bone thinning and weakening which can lead to fractures. Bone is living tissue that is constantly changing, and osteoporosis happens when bone loss exceeds new bone development. This is when calcium's role in the body becomes particularly evident. Calcium is not only the most abundant mineral found in the bone but it is also responsible for making bones strong. Patients suffering from osteoporosis need to create a suitable level of calcium in their diets. Calcium supplements are highly recommended. Because bone loss occurs without symptoms, people often do not know they are suffering from Osteoporosis until their bones become so weak that a sudden strain or fall causes a fracture. Considered a major public threat, over 44 million Americans are currently suffering from this "silent disease". If suspected, Osteoporosis can be easily detected by a bone mineral density (BMD) test. The BMD is similar to an x-ray but with less radiation.

National Osteoporosis Foundation recommends adults under age 50 need 1,000 mg of calcium and 400-800 IU of vitamin D daily and adults 50 and over need 1,200 mg of calcium and 800-1,000 IU of vitamin D daily. People who get the recommended amount of calcium from foods do not need to take a calcium supplement. These individuals, however, still may need to take a vitamin D supplement. Too much calcium may increase the chance of developing kidney stones in some people. Vitamin D is also crucial in maintaining bone health, as it works together with calcium. It is the Vitamin D that assists the body in absorbing calcium. Without the necessary level of Vitamin D in the body, ingested calcium is rendered ineffective.

To prevent and treat osteoporosis, the U.S. Food and Drug Administration (FDA) has approved medications to slow or stop bone loss and reduce the risk of fractures (broken bones). A comprehensive osteoporosis treatment program includes a focus on proper nutrition, exercise, and safety. We can assist in evaluating and developing individualized plan to take care of your Osteoporosis.

Calcium Supplements

Calcium is an important mineral involved in bone health and its supplementation is the building block for preservation and treatment of bone loss. Calcium consumption in early yrs of life can help build higher bone mass in adulthood and reduce the risk of fractures later in life. Calcium can also benefit other body systems by reducing blood pressure and cholesterol levels.

Premenopausal women and men should consume at least 1000 mg while postmenopausal women not taking estrogen should consume 1500 mg of Calcium a day. It is important to consider dietary calcium when considering the supplements. There are various types of Calcium supplements available in the market. Certain medications change the amount of calcium that is absorbed and /or excreted. Your healthcare provider can help you determine the best type, dose, and timing of calcium supplements for you. We can help tailor your requirements according to your medical condition.

Common side effects of Calcium include constipation and indigestion. Calcium supplementation can interfere with the absorption of iron and thyroid hormone, and therefore these medications should be taken at different times. Limited data suggests large amounts of calcium increases the risk of kidney stones especially if the supplement is taken between meals or at bedtime.

For more information regarding osteoporosis, calcium supplements and vitamin D www.NOF.org is an excellent resource.

Vitamin D

Vitamin D decreases bone loss and lowers the risk of fracture, especially in older men and women. Vitamin D along with Calcium helps prevent and treat osteoporosis. Vitamin D is required for Calcium absorption. Vitamin D is also made in the skin after exposure to sunlight. All adults should consume at least 800 international Units of vitamin D a day. Lower levels of vitamin D are not as effective while high doses can be toxic, especially if taken for long periods of time. Milk is the best dietary source of vitamin D, with approximately 100 IU per cup. Vitamin D is available as an individual supplement and is included in most multivitamins and some calcium supplements.

For more information regarding osteoporosis, calcium supplements and vitamin D www.NOF.org is an excellent resource.

Primary Hyperparathyroidism

There are four pea-sized glands in the neck that produce parathyroid hormone (PTH). Primary hyperparathyroidism (PHPT) is a condition in which an overactive parathyroid gland makes too much PTH. PTH keeps calcium at a normal level in the blood. When blood calcium gets low, PTH brings it back to normal by moving calcium from the bones, kidneys, and intestines into the blood. Too much PTH causes more calcium to be released from the bones, and raises levels of calcium in the blood and urine above normal. Over time, this can result in osteoporosis, kidney stones and a decline in kidney function.

Pituitary Disorders

The size of a pea, the pituitary gland is considered the "master gland". Resting at the base of the brain, the pituitary gland secretes hormones that regulate thyroid activity, growth during childhood, urine production and temperature. Most pituitary disorders are caused by benign tumors. Pressure from such tumors can cause visual disturbances, headaches, fatigue, weakness and seizures. The diagnosis is generally established by laboratory testing and may be an MRI. Treatment most often involves hormone replacement therapy by means of medication and surgery is indicated in some cases.

In other cases patients may lack a hormone due to a specific treatment of another condition unrelated to pituitary gland directly. If hormone deficiency is suspected, it should be worked up closely because it could be life threatening in certain situations if not replaced immediately. Two examples of such hormones are: Cortisol which regulates blood pressure and blood glucose levels, and ADH, which controls the body's water balance. Hormone replacement therapy is catered to each individual patient's needs. It is very important to monitor the replacement of hormones with periodic lab testing to avoid under/ over replacement of hormones.

For more information on pituitary disorders please visit: www.Hormone.org


The gonads: testes in men and ovaries in women are responsible for producing hormones and gametes (eggs or sperm). Hypogonadism is when the gonads experience decreased functionality, producing little or no hormones. This disorder appears differently in men and women.

For women, hypogonadism may cause infertility, hot flashes, and heart disease. Men, on the other hand, experience the following symptoms: poor libido, erectile dysfunction, high cholesterol, depression and anxiety. Imbalances in estrogen and progesterone in women, and testosterone in men, are not vital for survival but they are very valuable when it comes to living a healthy life. These hormones are important for reproduction and the maintenance of healthy bone mass. Hormone imbalances are one of the main causes of osteoporosis.

Both women and men receive treatment through hormone replacement therapy. Male hypogonadism is most often treated with testosterone replacement therapy (TRT). Testosterone can be administered by transdermal (through the skin) means; such as a patch, gel, or injections. During treatment blood tests are regularly administered to ensure the correct amount of testosterone is prescribed. For women, estrogen therapy comes in the form of a patch or pill. Women who have not had their uterus removed usually undertake a combination treatment that includes both estrogen and progesterone. Additionally testosterone can be added for women with hypogonadism who experience a low sex drive.

For additional information regarding hormonal conditions please visit: www.Hormone.org

Polycystic Ovary Syndrome (PCOS)

PCOS is the leading cause of female infertility, affecting approximately 5%-10% of women of reproductive age (12-45 years old). In PCOS small, benign cysts grow on the ovaries and cause hormonal imbalances. These hormonal imbalances cause symptoms that may be mild at first, but left untreated they can become serious.

Women suffering from PCOS often experience highly irregular menstrual periods, acne, obesity, extra hair on the face and body, thinning hair and depression. PCOS is diagnosed by lab tests, a thorough medical history, and a physical exam. In some cases the doctor with perform a pelvic ultrasound is ordered to look for cysts.

Treatment is necessary to improve symptoms and reduce the risks of developing more serious health problems. Regular exercise and healthy foods are key treatments for PCOS. In many cases weight loss can help regulate hormones. Birth control pills can also be prescribed to reduce symptoms and regulate menstrual periods. Other hormonal therapy options are available such as spironolactone, which is often used in conjunction with birth control pills.

For additional information on Polycystic Ovary Syndrome we recommend: www.Hormone.org