Hip Hop dancing with Type 1 – Brody’s got this!

Brody Coomler shares his insights on living with type 1 diabetesHip hop dancing can be tough for anyone, but not for Brody – a seventh-grader living with the challenges of Type 1 diabetes.

“Diabetes doesn’t change who I am,” said twelve-year-old Brody. “But it is a disease that I have to manage on a constant basis in order to stay safe.”

The moves? Brody’s practiced for years. The look? He’s got it on lock. The music? Please. So what happens when his insulin pump comes out during a performance? Brody’s got this.

Brody doesn’t miss a single beat – incorporating the pump wires into his routine.

The situation is a metaphor for Brody’s life. When Type 1 diabetes unexpectedly surfaced – he didn’t let it affect his dance, and Brody doesn’t let Type 1 stop him from playing basketball, gaming, learning to play the tuba or experiencing all life’s got to offer.

But Brody says it much better. “Don’t let type one diabetes stop you from doing anything!”

At four, Brody and his family learned his pancreas was creating little to no insulin – the hormone that regulates blood sugar. He was diagnosed with type 1 diabetes, a chronic and life-long condition that causes blood sugar to spike and fall unexpectedly.

Surging blood sugar levels are far more than a nuisance, they can lead to serious medical complications and death if not properly managed through insulin therapy.

“I have to check [my blood sugar] before meals and before bed,” Brody explained. “If I’m feeling like my blood sugar is too high or if I’m feeling like my blood sugar is too low I have to test. I am very active and so I have to test before I play any sports or any dancing. Monitoring my blood sugar is a big part of having diabetes.”

Even though this brave young-man doesn’t let Type 1 slow him down, he admits his life would be different if there was a cure.

“I would definitely be free from having to test my blood sugar, put on new insulin pump sites or wear a continuous glucose monitor – things like that,” Brody said. “I wouldn’t get sick as much as I get sick now. My mom wouldn’t call me as much.”

You can help kids like Brody by supporting Type 1 research through events like the JDRF Sip, Savor & Celebrate being held Friday, March 23 at La Encantada. Festivities start at 6 p.m. – enjoy live music, fantastic food and drink, and help move research closer to a cure.

Purchase tickets at www.celebratejdrf.com or call (520) 203-8084.

Why children with diabetes need a pediatric endocrinologist

Why see a pediatric endocrinologist

Let’s face it: children are physically, cognitively and emotionally strikingly different from adults. When children have diabetes these differences affect how they communicate and understand symptoms and treatment of the disease.

The pediatric endocrinology team at TMCOne is comprised of specialist providers and educators who support our pediatric patients and their families with developmentally appropriate care. Pediatric endocrinologists treat children with diseases of the endocrine system, such as those with diabetes or growth disorders. We talked to the team about treating children with diabetes:

My child has been diagnosed with diabetes, why should we see a pediatric endocrinologist?

Both children and adults can experience similar symptoms of high and low blood sugars, but younger children might have trouble expressing their symptoms to their parents or caregivers. As physicians and educators, we take extra time to explain complicated medical details to a child in terms they can understand.

The difference between treating children and adults with diabetes isn’t just in how we communicate, but also because we are treating a condition that is affected by the ongoing physiological and hormonal changes associated with growth.

As children grow, develop and experience puberty, their insulin requirements change. Children with diabetes need to have regular monitoring throughout these changes to adjust treatment plans, educate, and help with any problems that have developed around diabetes. The pediatric endocrinology team helps your child and you master the skills and knowledge whether it is a young child newly diagnosed, or the teen who learning to manage diabetes independently of their parents.

Regardless of age, however, a person with diabetes needs a supportive network of family, friends and health care professionals to troubleshoot the everyday or emergent events that can occur with diabetes, whether it is type 1 or type 2.

What is the difference between Type 1 and Type 2 diabetes?

Diabetes is a broad term used to describe a number of disorders with different origins and impacts. What Type 1 and Type 2 diabetes have in common is a problem with the hormone insulin.

The primary purpose of insulin is to pull glucose into the body’s cells. Without insulin, or without a full insulin dose, glucose remains in the blood, raising blood sugar levels in the individual. Both those with Type 1 or Type 2 diabetes must monitor and manage their blood glucose carefully to avoid both short-term symptoms and long-term complications. Both forms of diabetes are serious conditions that require medical care.

Type 1 diabetes

Cells in the pancreas of people with Type 1 diabetes do not make insulin. People with Type 1 diabetes must take insulin to control their blood glucose levels. Insulin can be delivered by injections or pumps. It’s usually diagnosed in children or young adults

Type 2 diabetes

Type 2 diabetes is the form of diabetes that affects a large portion of our adult community, but is seen increasingly in young children. When a person has Type 2 diabetes, insulin is still produced by the pancreas, but it does not work as well as a person without diabetes.

Unlike Type 1 diabetes, Type 2 diabetes is often associated with excess weight. Families are encouraged to use diet and exercise to help weight loss and reduce the body’s resistance to insulin if their child has Type 2 diabetes. In addition, medication may be used to make the insulin more effective. When those treatments do not work, insulin may be used.

Which type of diabetes is more common in children?

New cases of Type 1 and Type 2 diabetes among children are on the rise. Type 1 diabetes is significantly more common in children than Type 2 diabetes. Type 2 diabetes is found predominantly in adults 40 years and older. It is found occasionally in teenagers.

In the last decade, children have been diagnosed with Type 2 diabetes at a higher rate than before. The following risk factors are linked to the higher rates of Type 2 diabetes in children:

  • increased sedentary lifestyle
  • higher body mass index
  • excess of availability of processed foods

Helping children exercise and eat a healthy, balanced diet can help drive down the rates of Type 2 diabetes, but it cannot affect those with Type 1 diabetes. Children with Type 1 diabetes cannot prevent nor treat their lack of insulin through diet and exercise.

Can children acquire both types of diabetes?

A child can get either Type 1 diabetes or Type 2 diabetes. In general, of all the children in Southern Arizona with diabetes, about 85-90 percent have Type 1 diabetes.

It’s important to note that Type 1 diabetes and Type 2 diabetes are managed differently. Type 1 does not become Type 2 diabetes nor does Type 2 become Type 1.

Check out our blog posts about Type 1 diabetes.

When your child is diagnosed with Type 1 diabetes

Dr. Priti Gupta Patel, pediatric endocrinologist

Dr. Chetanbabu M. Patel, pediatric endocrinologist

Dr. Chetanbabu M. Patel, pediatric endocrinologist

When your child is diagnosed with Type 1 diabetes

type one diabetes diagnosed

“Our biggest goal in properly managing diabetes is to help the patient and family achieve a lifetime of good health.”

Dr. Priti and Chetanbabu M. Patel, TMCOne pediatric endocrinolgists

If your child has received a Type 1 diabetes diagnosis you may be feeling overwhelmed. While the condition develops gradually, the symptoms can seem to appear overnight.

Symptoms of Type 1 diabetes

  • Excessive thirst
  • Hunger or loss of appetite
  • Dry skin
  • Blurry vision
  • Numbness
  • Fruity breath
  • Excessive urination
  • Weight loss
  • Excessive sleeping
  • Irritability
  • Weakness
  • Delays in wound repair or infection control
  • Nausea and vomiting

Not all children will present with the same signs and symptoms. Some children may present with few or none of the above symptoms and some children may present with many.

Is there a cure for Type 1 diabetes?

While there isn’t a cure yet, the past decade and specifically since about 2014, leading-edge technology is helping the diabetes community.

Today some insulin pumps are capable of making micro adjustments to help the patient curb hyperglycemia (low blood sugar) and can turn off the insulin supply if the patient is experiencing hypoglycemia.

Continuous glucose monitors allow patients and families to glance at a screen at any moment to see glucose levels in real time. These advancements are without a doubt life-changing.

However, we still have not discovered the elusive cure. Until that time, it is imperative children with diabetes and their families feel supported and confident in their ability to control blood glucose levels. Please remember people with diabetes do incredible things every day. There are actors, Olympians, scientists and neurosurgeons with diabetes. People with diabetes can live long, productive and healthy lives!

Why is it so important that my child learns to manage Type 1 diabetes?

“We know that if we can help get the glucose (sugar) levels down in the first 5 years, those children will have a smaller number of complications than children who were not able to properly manage their diabetes,” said Dr. Patel. “The three main complications we try to prevent as an adult or older teenager are eye disease, kidney disease and nerve disease.”

Type 1 diabetes is a life-long condition with life-threatening implications if not under control. We know the habits children develop at an early age can stay with them for a lifetime. If children remain supported and encouraged to care for themselves early on, they can develop positive coping skills which can help keep them healthy and happy into adulthood.

What does it mean to ‘manage’ diabetes?

When people with Type 1 diabetes eat carbohydrates–whether whole wheat bread, pasta, fruit or candy–they must inject insulin into their body to help their body move the glucose out of the blood stream and into the cells. You must figure out just how much insulin to inject based upon the amount of carbohydrates consumed. As children’s bodies are constantly growing their insulin needs increase making this adjustment an ever changing target.

Learning how to count carbohydrates at every meal can be demanding for a family. Even families with the best routine can easily forget to cover carbohydrates at a busy family event or on a long road trip. The reality of it is that sometimes life gets in the way. Learning to plan, cope, organize and forgive yourself are some of the best tools for any new Type 1 diabetes family.

The child’s pediatric endocrinology team can be a support system to help the family understand how to safely manage changes in insulin requirements.

What should I do if I think my child may have Type 1 diabetes?

As noted earlier, some children present with few or none of the symptoms listed above, and some children may present with many.

Remember, children go through growth spurts and might ask for more water, might sleep a little more or might be constantly hungry. These symptoms might seem normal, but they could also be clues to a potential diabetes diagnosis.

If you’re concerned, don’t delay. Ask your child’s primary care provider for a glucose test. Depending on the result, the PCP may order additional tests, may start your child on insulin or have your child admitted to the hospital for close monitoring.

Don’t doubt your parental gut feeling! Untreated diabetes can escalate quickly to critical diagnoses like diabetes ketoacidosis or coma. If your child DOES have diabetes, TMC and TMCOne can form a team to help support your child to learn to care for this manageable chronic condition.

You can find the TMCOne pediatric endocrinologist contact information here.

“Diabetes doesn’t change who I am”

Brody Coomler shares his insights on living with type 1 diabetesTwelve year-old Brody Coomler refuses to let type 1 diabetes define him – he explains how a seventh grader balances a full schedule with the challenges of diabetes.  

He’s an avid basketball player, he’s a hip-hop dancer, he plays the tuba and he’s a gamer. Brody is an active and enthusiastic tween who doesn’t let diabetes keep him from doing the things he’s passionate about.

At four, Brody and his family learned his pancreas was creating little to no insulin – the hormone that regulates blood sugar. He was diagnosed with type 1 diabetes, a chronic and life-long condition that causes blood sugar to spike and fall unexpectedly.

Surging blood sugar levels are far more than a nuisance, they can lead to serious medical complications and death if not properly managed through insulin therapy.

Managing Type 1 diabetes can be demanding, especially for a young person. During National Diabetes Awareness Month, Brody shares how monitoring diabetes is part of his life, but hasn’t taken it over.

What does having Type 1 diabetes mean to you?

Diabetes doesn’t change who I am. But it is a disease that I have to manage on a constant basis in order to stay safe.

Do you have to check your blood sugar all the time?

Yes, I do! I have to check before meals and before bed. If I’m feeling like my blood sugar is too high or if I’m feeling like my blood sugar is too low I have to test. I am very active and so I have to test before I play any sports or any dancing. Monitoring my blood sugar is a big part of having diabetes.

Do you have a special diet?

No, I don’t have a special diet. But like anyone I have to watch what I eat. I count my carbohydrates so that I can dose my insulin based on what I’m eating.

Does diabetes ever get in the way of sports or hobbies?

It definitely does. When I have low blood sugar I have to sit out of a sport or not be able to participate. I have to make sure that my blood sugars are in good range so that not only am I safe but also so that I can perform.

What do you want people to know about having Type 1 diabetes?

Don’t let Type one diabetes stop you from doing anything!

How would things be different for you if there was a cure?

I don’t let diabetes hold me back, but I would definitely be more free from having to test my blood sugar, put on new insulin pump sites or wear a continuous glucose monitor – things like that. I wouldn’t get sick as much as I get sick now. My mom wouldn’t call me as much.

What would you tell a friend who just found out they have Type 1 diabetes?

I would suggest that they make other friends who have Type 1 diabetes so that they can help one another. My friends with diabetes are a good support to me. You can expect the unexpected. You get to have some fun times and meet people that you didn’t think that you would otherwise meet.

For more information about Type 1 diabetes and how you can support research for a cure, visit the JDRF website or call (800) 533-CURE (2873).

TMCOne provides adult and pediatric endocrinology services – for more call (520) 324-4900.

 

Stay in optimum health, prevent metabolic syndrome

Tips from Endocrinologist Dr. Pati on how to prevent metabolic syndrome

Are you at risk for developing metabolic syndrome?

Metabolic syndrome, which often carries no signs or symptoms, is associated with several obesity related disorders including fatty liver and cirrhosis, kidney disease, polycystic ovarian syndrome, and obstructive sleep apnea. It places those affected by the syndrome at increased risk of developing diabetes and heart disease – and they never even know they have it!

Dr. Divya Reddy Pati, endocrinologist with TMCOne, answers our questions about this metabolic syndrome.

Tell me more. What is metabolic syndrome?

Metabolic syndrome, also known as insulin resistance syndrome or syndrome x, is a group of factors that increase the risk of developing diabetes, heart disease and stroke.

Insulin is a hormone produced by the pancreas that helps move blood sugar into the cell where it is used for energy. Obesity causes insulin resistance, which leads to high blood glucose.

How is it diagnosed?

A physician who specializes in endocrinology can prescribe the medical tests that diagnose metabolic syndrome, which is determined by a presence of three of the following:

  • Abdominal obesity, defined as a waist circumference in men ≥102 cm (40 in) and in women ≥88 cm (35 in)
  • Serum triglycerides ≥150 mg/dL or drug treatment for elevated triglycerides
  • Serum HDL cholesterol <40 mg/dL in men and <50 mg/dL in women or drug treatment for low HDL cholesterol
  • Blood pressure ≥130/85 mmHg or drug treatment for elevated blood pressure
  • Fasting plasma glucose ≥100 mg/dL or drug treatment for elevated blood glucose

What is the prevalence of metabolic syndrome?

Metabolic syndrome is more common in African-Americans, Asians, Hispanics and Native Americans. Chances also increase with age, as well as with lack of physical activity.

What is the treatment?

Treatment of metabolic syndrome is aggressive lifestyle modification focused on weight loss and increase in physical activity. Weight reduction is optimally achieved by diet, exercise and pharmacological treatment if needed. Medications are used to treat risk factors such as high blood pressure, glucose and lipids.

What do you suggest we do to stay in optimum health?

It is important to visit your primary care physician regularly and address an endocrinology specialist if metabolic syndrome is encountered. Maintaining a healthy diet and an exercise plan (approved by your provider) is an excellent way of avoiding metabolic syndrome and maintaining optimum health.

pati1Dr. Divya Reddy Pati is an endocrinologist practicing with TMCOne. She diagnoses and treats diabetes, thyroid problems, calcium disorders, osteoporosis, pituitary, adrenal and other hormonal disorders.

 

A version of this interview was first posted on December 21, 2016

 

Endocrinology addresses thyroid health challenges

Dr. Divya Reddy Pati addresses thyroid health issues, endocrinology

by Divya Reddy Pati M.D.

You have probably heard the term thyroid, but are you aware of its significance and that it can involve health challenges? Thyroid issues are relatively commonplace and most cases are easily treated. An endocrinologist can best address thyroid problems and determine the best means of treatment.

What is the thyroid gland?

The thyroid gland is a butterfly-shaped gland located in front of the neck. This vital gland produces the thyroid hormone that helps regulate the body’s metabolism.  

 Prevalence

Thyroid-related health challenges, such as thyroid nodules, are very common. Nodules can create too much thyroid hormone or no thyroid hormone at all. Most are benign, although a very small percentage can be cancerous.

What is a nodule?

A thyroid nodule is a growth or lump on the thyroid gland, and is usually discovered by a patient, in a routine physical exam or incidentally by imaging. There are usually no symptoms associated with a nodule, although a nodule that is large may sometimes cause a change in voice or difficulty swallowing or breathing.

What are the risks?

The risk of developing thyroid nodules increases with age. While most thyroid nodules are benign (non cancerous,) the prevalence of cancer is higher in children and adults younger than age 30 or over age 60. There is an increased cancer risk for individuals who have a family history of thyroid cancer, and for patients who have received radiation therapy of the head and neck.

Endocrinology

Endocrinology is the medical study and treatment of hormones and endocrine glands, like the thyroid gland. An endocrinologist is a physician who specializes in this area, and will order lab tests to determine if the nodule is hot (overproducing) or cold (not producing). An ultrasound is needed to further determine the type of nodule, and give the endocrinologist information needed to determine the most effective treatment plan.

Based on the type of nodule, a specific biopsy, guided by ultrasound, will be ordered to best identify the nodule.

Treatment

Treatment of thyroid nodules depends on the type of nodule.

If a biopsy shows a benign nodule, monitoring might be recommended every 6 to 12 months with a physical exam and/or a thyroid ultrasound.

Surgery is only recommended for nodules that are cancerous or suspected of being cancer. In the rare situation that nodules are large enough to cause problems with swallowing or breathing surgery might also be recommended.

Regular provider visits

Thyroid nodules should always be addressed. While most are not harmful, there is a small risk of cancer.  Your health care provider can make the appropriate referral to an endocrinologist, one of the many reasons it is important to visit your primary care provider and receive periodic physicals.

divya pati endocrinologistDr. Divya Pati is an endocrinologist practicing with TMCOne. She diagnoses and treats diabetes, thyroid problems, calcium disorders, osteoporosis, pituitary, adrenal and other hormonal disorders.

Stay in optimum health, prevent metabolic syndrome

Optimum Health .jpgDid you know that some people have a syndrome that places them at increased risk of developing diabetes and heart disease – and they never even know they have it?

Metabolic syndrome, which often carries no signs or symptoms, is also associated with several obesity related disorders including fatty liver and cirrhosis, kidney disease, polycystic ovarian syndrome, obstructive sleep apnea.

Tell me more. What is metabolic syndrome?

Metabolic syndrome, also known as insulin resistance syndrome or syndrome x, is a group of factors that increase the risk of developing diabetes, heart disease and stroke.

Insulin is a hormone produced by the pancreas that helps move blood sugar into the cell where it is used for energy. Obesity causes insulin resistance, which leads to high blood glucose.

How is it diagnosed?

A physician who specializes in endocrinology can prescribe the medical tests that diagnose Metabolic syndrome, which is determined by a presence of three of the following:

  • Abdominal obesity, defined as a waist circumference in men ≥102 cm (40 in) and in women ≥88 cm (35 in)
  • Serum triglycerides ≥150 mg/dL or drug treatment for elevated triglycerides
  • Serum HDL cholesterol <40 mg/dL in men and <50 mg/dL in women or drug treatment for low HDL cholesterol
  • Blood pressure ≥130/85 mmHg or drug treatment for elevated blood pressure
  • Fasting plasma glucose ≥100 mg/dL or drug treatment for elevated blood glucose

Prevalence

Metabolic syndrome is more common in African-Americans, Asians, Hispanics and Native Americans. Chances also increase with age, as well as with lack of physical activity.

Treatment

Treatment of metabolic syndrome is aggressive lifestyle modification focused on weight loss and increase in physical activity. Weight reduction is optimally achieved by diet, exercise and pharmacological treatment if needed. Medications are used to treat risk factors such as high blood pressure, glucose and lipids.

Optimum health

It is important to visit your primary care physician regularly and address an endocrinology specialist if metabolic syndrome is encountered. Maintaining a healthy diet and an exercise plan (approved by your provider) is an excellent way of avoiding metabolic syndrome and maintaining optimum health.

pati1

Divya Reddy Pati, M.D.

Dr. Divya Pati is an endocrinologist practicing with TMCOne Medical Group. She diagnoses and treats diabetes, thyroid problems, calcium disorders, osteoporosis, pituitary, adrenal and other hormonal disorders.

TMC One Med Group your health your team OL

Type 1 vs. Type 2 Diabetes: Under new management

No doubt, a diabetes diagnosis changes a person’s life.  They may find themselves doing things they’ve never had to do before, like check their blood sugar multiple times a day, count carbohydrates, and perhaps even give themselves insulin shots.  Even starting an exercise plan may be a first for them.  The good news is that diabetes educators are available to help.  Diabetes educators are health care professionals who teach those with diabetes how to adjust their lifestyle and behavior so that they can successfully manage their disease.

Nancy KlugTMC Certified Diabetes Educator

Nancy Klug
TMC Certified Diabetes Educator

TMC Certified Diabetes Educator Nancy Klug developed her passion for educating others about diabetes after two close family members were diagnosed with it.  She’s been helping diabetics understand their disease, and get their blood sugar under control for more than 25 years.  She shares some valuable information about appropriate diabetes testing, and how the disease is managed.

Type 1 Diabetes

Background:  People with Type 1 diabetes often get strong symptoms that could land them in the emergency room.  Their blood sugar may be 300 or higher.  Many times they are very sick.  They may be vomiting, and even have trouble breathing.  Other symptoms include increased urination.  They may find themselves getting up many times during the night to use the restroom.  They’re also very thirsty, and extremely tired.  Rapid weight loss is another common symptom we see.  Many times Type 1 affects people who are under age 30.  There is a hereditary factor, but it’s not as strong as it is in Type 2.

Appropriate Testing:  A test called c-peptide is done.  This tells a clinician if the patient is making insulin.  They’ll also do some antibody testing to see if the patient has the antibodies that would kill their beta cells. 

Managing Type 1:  Type 1 diabetics will start on insulin right away.  They’ll need at least four shots a day.  A short-acting insulin at each meal, and then a long-acting insulin.  Or, they may be on an insulin pump.  There is no cure for Type 1, but like Type 2, it can be controlled.

Type 2 Diabetes

Background:  With Type 2 diabetes, there s a very strong hereditary factor, but it is possible for someone to develop it without having a family history.  The tricky part with Type 2 is that oftentimes it’s difficult for people to tell they have the disease, as there are no, or very few, symptoms.  Patients may have to get up in the middle of the night to use the restroom.  They also may be a little thirstier or more tired than usual, and have a wound that is slow to heal.  Unlike Type 1 diabetics, Type 2 diabetics do not have weight loss.  If diabetes goes uncontrolled for several years, complications can develop, including kidney, nerve and eye damage.  The biggest complication, however, is heart attack and stroke.

Appropriate Testing:  A physician who suspects a patient has diabetes will order an A1C test.  The blood test gives the physician an average of the patient’s blood sugar over the last three months.  A non-diabetic person may have an A1C around 4-6 percent.  Prediabetes is 5.7-6.4 percent.  A diabetes diagnosis is 6.5 percent or higher.

Managing Type 2:
  The American Diabetes Association recommends patients start on a medication called Metformin.  Patients are advised exercise at least 30 minutes, five times a week, and attend diabetes education classes where they’ll learn how to count their carbs, and keep them down, along with their saturated fat intake.  Eighty percent of Type 2 diabetics are overweight, so losing even a little weight can be very beneficial.

The American Diabetes Association (ADA) suggests Type 2 diabetics have a blood sugar range of 70-130 before meals, and 130-180 two hours after meals.  The American College of Endocrinology (ACE) has even stricter guidelines.  They recommend a blood sugar level of under 110 before meals, and under 140 two hours after meals.  At TMC, Klug says they teach patients both sets of guidelines, encouraging them to get into the ADA range first, and then aim for the ACE range.

In conclusion, Klug says, “The good news is that we know how to control diabetes.  Patients have to learn how to do it, but a diabetes educator and their team can work with you.  If you’re able to keep your numbers down, you can minimize the complications and have a fairly healthy life.  There’s nothing that you can’t do with diabetes.  There is no cure, and it will never go away, but you can get it under control.”

If you or someone you know has diabetes and wishes to speak to a diabetes educator at TMC, please call (520)324-3526 or (520)324-1265.


Tucson Medical Center | 5301 E. Grant Road | Tucson, Arizona 85712 | (520) 327-5461