Programs and Disease Treatment
The most prevalent endocrine disease in the United States is diabetes mellitus (commonly called diabetes). Diabetes is a chronic disease in which the body does not produce or properly use insulin, a hormone produced by the pancreas. Insulin is needed to convert sugar, starches and other food into energy for daily life. According to the American Diabetes Association, an estimated 23.6 million people in this country have diabetes.
The pancreas, a large gland in the abdomen, produces insulin and glucagon to regulate the level of sugar carried in blood. Diabetes, characterized by high blood sugar (hyperglycemia), occurs when the pancreas does not make any insulin, or it does not make enough insulin, or the body is not able to use the insulin the pancreas makes.
Diabetes is associated with long-term damage to and failure of various organs, especially the eyes, kidneys, nerves, heart and blood vessels. There are two main types of diabetes.
In Type 1 diabetes, which affects about 10 percent of Americans diagnosed with diabetes, the body is unable to produce insulin.
In Type 2 diabetes, the cells of the body are resistant to insulin, primarily because of obesity. The pancreas produces more insulin, but it is not enough to overcome the resistance, resulting in elevated blood sugar levels.
In addition, there are many (less common) types of diabetes that are associated with other conditions. These include:
- Pregnancy (gestational diabetes affects about 4 percent of pregnant women who have never had diabetes before, but who have high blood sugar levels during pregnancy)
- Genetic defects in insulin action (gene mutations that impair insulin secretion in the pancreas)
- Endocrinopathies (excess production of certain hormones in the body that inhibit insulin action)
- Drug- or chemical-inducted diabetes (drugs/chemical that impair insulin secretion)
- Diseases of the pancreas such as pancreatitis, trauma, infection and cancer
- Uncommon forms of immune-mediated diabetes
- Other genetic syndromes
Pre-diabetesPre-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. People who have pre-diabetes have a high risk for developing Type 2 diabetes. Pre-diabetes is also referred to as impaired fasting glucose or impaired glucose tolerance, depending on the test used. In many cases, progression from pre-diabetes to Type 2 diabetes can be prevented with lifestyle changes (diet changes and exercise) and weight loss.
Diabetes Diagnostic TestingThe following glucose tolerance tests are used to diagnose diabetes:
A fasting plasma glucose (FPG) test measures blood glucose in a person who has not eaten anything for at least eight hours (overnight fast). The person’s fasting plasma glucose is tested. This test is used to detect diabetes and pre-diabetes.
An oral glucose tolerance test (OGTT) measures blood glucose after a person fasts at least eight hours and two hours after the person drinks 75 grams of sweet-tasting liquid containing glucose. Blood samples are then taken up to four times to measure the blood glucose level. This test can be used to diagnose diabetes and pre-diabetes.
Gestational diabetes is also diagnosed with the OGTT. A pregnant woman’s blood glucose level is checked before the test. After drinking 100 grams of glucose in liquid, blood glucose levels are checked one, two, and three hours later.
Diabetes TeamDiabetes can be successfully managed through lifestyle changes and medication. The key to successful self-management is developing a care plan that fits a patient’s lifestyle. The Diabetes Care Center team focuses on diet, exercise, education, medication and disease monitoring. The program is unique in offering a continuum of care to all patients, whether someone is newly diagnosed or experiencing chronic complications associated with diabetes.
The Froedtert & The Medical College of Wisconsin Diabetes Care Center offers educational programs and classes to help people with diabetes better understand and manage their disease. In 1988, it was the first program in Wisconsin to receive recognition from the American Diabetes Association for meeting national standards of excellence in diabetes education.
Team members include endocrinologists, nurses who are certified diabetes educators (CDE), registered dietitians (also CDE), and the patient’s primary care physician. The patient is considered the captain of the team.
Inpatient Diabetes ManagementThe multidisciplinary diabetes teams are dedicated to improving blood sugar control of hospitalized patients. Comprehensive diabetes management and basic diabetes education are provided to all inpatients, targeting blood sugar control during hospitalization, regardless of the severity of the patient’s condition.
Three dedicated teams meet the special needs of inpatients with diabetes:
- Diabetes Management Team, consisting of an endocrinologist, nurse practitioner and physician assistants, provides direct patient care and blood sugar surveillance.
- Diabetes nurse educators to teach patients self-management.
- Diabetes Assessments and Resource Team (DAART) provides surveillance and feedback to the Diabetes Management Team for hospitalized patients who take insulin. These patients are at higher risk for complications when hospitalized. This proactive approach, in use hospital-wide, has yielded significant results in better management of patients on insulin.
Patients with diabetes in the Intensive Care Unit benefit from an insulin drip that provides 24-hour insulin administration. Software (insulin drip calculator) to control the drip was created by Medical College of Wisconsin endocrinologist Paul Knudson, MD.
Outpatient Diabetes ManagementIn the Diabetes Clinic at Froedtert & The Medical College of Wisconsin, an endocrinologist and certified diabetes educators (nurse and dietitian) see patients for ongoing diabetes care. In addition to teaching patients diabetes self-management, the clinic offers patients the latest diabetes technology, including insulin pumps, self-monitoring glucose meter downloading and on-site rapid AIC measurement.
People who have other health problems associated with diabetes require specialized care. When needed, patients are referred to other Medical College of Wisconsin physicians. For example, if a patient has diabetic retinopathy, an ophthalmologist will become part of the patient’s care team. If a patient is experiencing peripheral vascular disease, he or she will be referred to a vascular physician.
Comprehensive outpatient diabetes care is also provided by Medical College of Wisconsin physicians at the Endocrinology Center at Community Memorial Medical Commons, located at W129 N7055 Northfield Drive in Menomonee Falls. The physicians are all medical staff members at Community Memorial Hospital.
Endocrine Disorders in Pregnancy ClinicWhen a woman develops diabetes during pregnancy (gestational diabetes), she and her fetus require special care. The same is true for a woman who has Type 1 or Type 2 diabetes and then becomes pregnant. The Endocrine Disorders in Pregnancy Clinic meets the special needs of diabetic women during pregnancy.
Diabetes TechnologyPatients with diabetes benefit from the most advanced testing and technology available, aimed at reducing the burden of living with their disease.
Types of Diabetes and ComplicationsFroedtert & The Medical College of Wisconsin endocrinologists are knowledgeable and experienced in treating people with all forms of diabetes, including people who have other health conditions as well, which can make diabetes management more challenging. For example:
Cystic fibrosis (CF) can harm the pancreas and lead to diabetes. People with cystic-fibrosis-related diabetes (CFRD) have different insulin requirements than people with diabetes who do not have CF. A person with CF and diabetes also has greater nutritional needs than a typical person with diabetes.
- Partial removal of the pancreas may lead to the onset of diabetes, while total removal of the pancreas is a clearly defined form of unstable diabetes. These patients tend to be very insulin sensitive, and small changes in insulin dose can make big differences in glucose levels.
- People with diabetes who undergo solid organ transplantation (e.g. receiving a new liver) receive glucocorticoids, which make diabetes management more challenging.
Patients with these health problems tend to require more hospitalization. Medical College of Wisconsin endocrinologists and other members of the diabetes team follow these patients through the continuum of their care — from outpatient to inpatient. Diabetes care complements and integrates with other teams that care for patients with more challenging forms of diabetes.
Diabetes may occur as the result of many other conditions (called secondary diabetes). Medical College of Wisconsin endocrinologists work with other Medical College specialists to address the unique needs of patients who develop diabetes associated with:
- Recurrent pancreatitis
- Anti-HIV therapy/AIDS patients on highly active anti-retroviral therapy
- Iron overload syndromes
- Medications that can cause complications
- Pregnancy (women with diabetes who become pregnant)
- Gestational diabetes (diabetes that occurs only during pregnancy)
- Maturity onset diabetes of youth
- Maturity onset diabetes of youth and pregnancy
- Autonomic nervous system dysfunction
- Diabetic gastroparesis (delay gastric emptying)
- Orthostatic hypotension
- Gustatory sweating
- Macrovascular complications (coronary heart disease, peripheral vascular disease, stroke hypertension, other complications)
- Hypoglycemic unawareness
- Recurrent hypoglycemia
- Diabetic cachexia
- Erectile dysfunction
Care for Complications of DiabetesMedical College of Wisconsin physicians are also highly experienced in treating patients with complications of Type 1 and Type 2 diabetes, including:
- Type 1 diabetes without microvascular complications
- Type 1 diabetes with microvascular complications
- Type 2 diabetes without microvascular complications
- Type 2 diabetes with microvascular complications
- Diabetic retinopathy
- Peripheral neuropathy
- Diabetic foot ulceration
- Charcot joint
- Diabetic nephropathy
- Chronic kidney disease
Diabetes Support GroupFroedtert & The Medical College of Wisconsin conduct a diabetes support group every other month. Topics include diabetes 101, meal planning for the holidays, diabetic foot care, new advances in treatment and metabolic syndrome in addition to a variety of other topics of interest to members of the group to improve self management skills and awareness.
Additional information on diabetes is available at diabetes.org, the Web site of the American Diabetes Association.
Diabetes ResearchFroedtert & The Medical College of Wisconsin are engaged in many clinical trials for diabetes and related disease. These include:
- In collaboration with faculty at Marquette University, clinical researchers are evaluating non-invasive testing of vascular integrity of patients with diabetes.
- In collaboration with scientists at Syracuse University, a study is evaluating a non-invasive glucose monitoring device.
- In collaboration with scientists at the University of Wisconsin-Milwaukee, research is looking at laser technology to assess the vasculature of the retina.
- A study will soon be underway to examine inpatient insulin resistance in post-operative coronary artery bypass patients.
- In collaboration with Edith Burns, MD, a computer program is being developed to provide diabetic patients with self-management advice based on trends from their glucose meters.
- An initiative is underway to develop an inpatient data warehouse for diabetes surveillance.
- A study is being conducted to assess individual differences in how cholesterol is metabolized.
- A protocol is in development to conduct an industry-sponsored, Phase II, multi-center randomized, double-blinded, placebo-controlled study to evaluate the safety and efficacy of PROCHYMAL™ for the treatment of recently diagnosed Type 1 diabetes.
Last Review Date: June 26, 2013
Online Editor(s): Andy Monigal