Diabetes

Diabetes is the most common endocrine disorder and it falls under the endocrine specialty because the hallmark of Diabetes Mellitus is insulin deficiency and insulin is a hormone. Diabetes has dietary and genetic components. We help with diabetes management, whether it is type 1, 2, or any other kind. We utilize technology such as continuous glucose monitoring systems (CGM), like the DEXCOM and iPro, to optimize glycemic control. For insulin-requiring patients, we offer insulin pumps, such as the Medtronic pump, Omni Pod, T-slim, Animas (including the CGM integrated VIBE pump), as well as various insulin pens and the new inhaled insulin, Afreeza.

Type 2 Diabetes

Type 2 Diabetes Mellitus is the most common form of diabetes, affecting almost 30 million Americans. The signs and symptoms of the disease include increased urination (polyuria), increased thirst (polydipsia), fatigue, weight loss (due to the inability to metabolize glucose and dehydration) and itchiness (pruritus).

In recent years, our understanding of the disease and development of novel therapies have significantly improved patients’ longevity and quality of life and lowered the risk of developing complications such as heart disease, kidney failure, changes in vision, and nervous system abnormalities. The approach to the treatment of diabetes is to individualize therapy and use medications that address the specific pathophysiology of this condition in the hope of changing its course. In diabetes, the pancreatic beta cells, which produce insulin, are impaired so we have medications that can increase insulin production.

Glucagon Levels

The alpha cells of the pancreas are responsible for making glucagon, a counter-regulatory hormone to insulin, which leads to increased glucose production to maintain blood sugars in the fasting state. In patients with diabetes, the glucagon level is abnormally high and elevated even after meals, which contributes to the high blood sugars.

Medications

We use medications such as Metformin or incretin-based medications such as DPP4 inhibitors and GLP-1 receptor agonists that can suppress glucagon release. Some of the incretin medications can also help with weight loss which may be a secondary benefit in some patients. Insulin resistance is another important factor in diabetes and it leads to an increased insulin requirement.

We have medications that can lower insulin resistance and improve the effects of insulin. The kidneys play an important role in glucose homeostasis as well and a new family of drugs, called SGLT2 inhibitors, is now available to help lower glucose levels by enhancing urinary glucose excretion.
Given the complexity of the different treatment options, one must take into consideration the types of medications, side effect profiles, kidney and liver functions, risk of hypoglycemia, and other medical problems a patient may have when individualizing a treatment regimen.

Our Approach

We have extensive experience in treating patients with diabetes. Since our focus is on the patient, we follow a comprehensive approach combining oral and injectable pharmacotherapy, dietary consultations and individualized monitoring while listening to patient’s unique concerns and taking into account his or her preferences, cost, and insurance coverage.