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.

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.

Need a primary care doc? TMC One welcomes new internal medicine physician

Dr. Katie Kellogg Internal Medicine TMC One

Dr. Katie Kellogg
Board-Certified, Internal Medicine
TMC One

Mutual trust and respect are two things Dr. Katie Kellogg believes are essential for a successful relationship between a patient and physician. Dr. Kellogg is an internal medicine physician who is new to TMC One. Her focus is on helping her patients prevent diseases and educating them on how to best manage their health. Dr. Kellogg is available to treat patients at TMC One’s Wyatt office, conveniently located on the TMC campus.

Learn more about Dr. Kellogg, her approach to caring for others and how a personal experience impacted her decision to go into medicine. 

What is your background? 

I was born and raised in Southern Colorado. I attended Colorado College for my undergraduate degree. I then went to the University of Colorado for medical school and training. I practiced with Kaiser for a year before moving to Montana where I practiced for five years. I am delighted to now be in Tucson.

What inspired you to become a PCP?

I wanted to become a primary care physician because I have a desire to care for the whole patient rather than focusing on one organ or disease state.

What made you decide to come to Tucson?

I wanted to come to Tucson because I love sunshine and the opportunity to be outdoors all year.

What do you think is the biggest health risk facing Southern Arizonans?

Like all of America, I think the biggest health risk facing Southern Arizonans is obesity and the medical problems that accompany it including diabetes, high blood pressure, heart disease and increased risk for many cancers.

Do you have any areas that are of particular interest to you, both in medicine and also outside of work?

I enjoy working with patients to prevent disease as well as helping them to manage chronic illnesses like diabetes and high blood pressure. Outside of work, I mountain bike, scuba dive, camp and ride dual sport motorcycles.

Why is it so important for people to get established with a practitioner before they get sick?

We often focus on disease control in our country. Prevention of disease and promotion of wellness should be more emphasized. Often, by the time people realize they are sick due to a chronic illness, irreversible damage has already been done. By working with a provider to monitor overall health early on, many of the complications related to chronic disease can be prevented.

What has been your most valuable life experience that has impacted your medical career?

The most valuable life experience that has impacted my medical career is when my grandfather was diagnosed with terminal lung cancer when I was age 13. We were extremely close. We played Cribbage and I cooked him dinner at least once a week while he was ill. Watching the illness affect him so quickly and watching the Hospice team help him focused me towards medicine.

How do you approach your relationship with your patients?

I like to work with my patients as a team. I like patients to feel they have some control over what happens with their health. I feel that mutual trust and respect are essential in the patient/physician relationship.

Dr. Kellogg is located at TMC One’s Wyatt office, 2424 N. Wyatt Drive, #100, on the TMC campus.
Valet parking is available! Dr. Kellogg is acc
epting new patients.
Call (520) 324-TMC1 (8621) to make an appointment.

TMC One’s new nurse practitioner ready to partner with you and your family

Maria

Maria “Maricruz” Bustamante 
Family Nurse Practitioner
TMC One

Maria “Maricruz” Bustamante is a board-certified family nurse practitioner with TMC One who is ready to provide compassionate health care for you and your entire family during every phase of life. Bustamante partners with her patients of all ages to help them achieve health and well-being with a focus on disease prevention. She blends her expertise and passion about fitness, nutrition and wellness coaching to help her patients achieve their goals, whether they be weight loss, increasing strength, reducing or eliminating medication, managing chronic health concerns, or decreasing pain.

Bustamante is also fluent in Spanish.

▪ What is your background?

I am a registered nurse with more than 12 years of intensive care experience. I have worked at all the local ICUs in town throughout my career. I decided to further my education in hopes of preventing patients from being admitted to the ICU from things like a high blood pressure crisis and diabetes complications.

▪ What inspired you to go into primary care?

I am a firm believer that health care starts in the home. I enjoy empowering parents to lead the way for their children in the hope that good health will be passed from one generation to another. I want to care for the whole family. Knowing and understanding the dynamics of an entire family allows me to better tailor the care plan for the family as a unit.

▪ What made you want to practice in Tucson?

I was raised here, so Tucson is and always will be a special place for me. I understand the culture and I see the need for people to do better for themselves. It is my sincere hope to help them make that happen by focusing on health care as wellness, not disease management.

▪ What do you think is the biggest health risk facing Southern Arizonans?

I believe the biggest health risk facing Southern Arizonans is obesity. In most cases, obesity is preventable. I strongly believe that if we educate our patients and empower them to take control of their well-being, many diseases can be prevented.

▪ Do you have any areas both in your practice and outside of work that are of particular interest to you?

In primary care, I love caring for the entire spectrum from newborns to the elderly. I especially enjoy pediatrics and women’s health, as well as helping patients manage their diabetes. When I’m not working, you’ll likely find me outside hiking and enjoying nature. For indoor activities, I love breaking a sweat with Zumba classes and really experience the health benefits of yoga.

▪ Why is it important for people to get established with a primary care provider before they get sick?

It is so important for people to get established with a primary care provider before they get sick because many specialty care needs can be prevented. I strive to help my patients and their families with disease prevention. I approach every patient holistically and team with them to best meet their health care needs. Being under the supervision of a primary care provider can also help in coordinating care for those times when specialty care is needed.

▪ What has been your most valuable life experience that has impacted your medical career?

My most valuable life experience that has impacted my medical career has been my time as an ICU nurse. It taught me not to take life for granted and showed me how quickly our loved ones can be taken from this earth.

▪ How do you approach your relationship with your patients?

I approach my relationship with my patients as a partnership. I love empowering them to take control of their health and will be there for them along the way, acting like their biggest cheerleader and guide.

Maricruz Bustamante is located at TMC One, 5295 E. Knight Dr., right across from TMC.
She is accepting new patients! Call (520) 324-1010 to make an appointment.

New TMC One endocrinologist is now available to tackle an assortment of complex cases

Dr. Shubh Preet Kaur Board-Certified Endocrinologist  TMC One

Dr. Shubh Preet Kaur
Board-Certified Endocrinologist
TMC One

Tucson Medical Center and TMC One, formerly Saguaro Physicians, are proud to welcome Dr. Shubh Preet Kaur, a board-certified endocrinologist who is accepting new patients. She specializes in diagnosing and treating diabetes, thyroid disorders, adrenal and pituitary gland disorders, metabolic disorders, menstrual irregularities, osteoporosis and calcium disorders.

“I believe in providing the same care to each patient that I would want for my family. My goal is to provide evidence-based, cost-effective and personalized health care of the highest quality to all my patients,” said Dr. Kaur.

Learn more about Dr. Kaur, her unique approach to patient care and why she really knows firsthand what challenges diabetics face:

What is your background?

I grew up in India and completed medical school there before starting a residency in internal medicine at Rochester General Hospital in upstate New York. I was then presented with a great opportunity to be the chief resident for the Internal Medicine Residency Program at the University of Arizona. I went on to complete an endocrinology and metabolism fellowship here at the University of Arizona.

What inspired you to go into Endocrinology?

I find complexities of the endocrine system challenging and fascinating. Having multiple family members with diabetes inspired and attracted me further to care for people suffering from diseases of the endocrine system.

How do you help primary care physicians care for their patients with diabetes?

Diabetes is a very complex disease, which affects almost all the organs of the human body. I help primary care physicians care for patients affected by this dreadful disease in whom simple medication regimens do not work, whose disease is hard to control or whose disease has progressed to a stage of complete insulin dependence or overt organ damage. Together, we help patients maintain optimal metabolic goals with the latest the field has to offer. I work with my patients to help them prevent further complications and maintain a healthy and independent lifestyle. Multiple other specialists also help us provide the best possible care to our patients.

At what point does a diabetic patient need to see an endocrinologist rather than just receive care from a primary care physician?

Patients are usually referred to an endocrinologist for adrenal, pituitary, thyroid and calcium metabolism-related issues. Patients with diabetes are often referred if the disease is hard to control, progresses to a state where they require complex medication regimens, have wide blood sugar ranges, multiple complications or if they are having difficulty getting to their target blood sugars.
After completing your endocrinology fellowship from the University of Arizona, what made you decide to stay in Tucson?

My training brought me to Tucson. I never thought I would stay here long, and now I don’t think I will ever leave. The small town feel with the amenities of a big city, great outdoors and the warm weather keep me in Tucson.

What interests you outside of work?

I try to spend as much time as possible with 2-year-old daughter, taking her to the zoo to meet her favorite animal, Nandi, the baby elephant.

What has been your most valuable life experience that has impacted your medical career?

My parents have diabetes so I have firsthand experience about how difficult it can be on patients and their families. I think of my parents when I see my patients and strive to improve their quality of life.

How do you approach your relationship with your patients?

I believe in providing the same care to each patient that I would want for my family. My goal is to provide evidence-based, cost-effective and personalized health care of the highest quality to all my patients.

Dr. Kaur is located at TMC One, 5295 E. Knight Dr., right across from TMC.
She is accepting new patients! Call (520) 324-1010 to make an appointment.
Standard office hours are Monday through Friday, 8 a.m. – 4 p.m.

“She gained as much as she gave.” TMC Volunteer contributes to major improvements for diabetics’ care

Marjorie Zismann TMC Volunteer

Marjorie Zismann
TMC Volunteer

“You have diabetes.  Buy a book.”

That’s what Marjorie Zismann’s doctor told her when he diagnosed her with type 2 diabetes in her early 60’s.  Since then, attempts to understand her disease have left her completely frustrated. Every day, she weighs herself, pricks her finger, squeezes out a drop of blood to check her blood sugar and takes her medication. Mealtimes consist of sorting out “yes” foods from “no” foods, which leaves her feeling restricted with little control over her disease.

Now 78 years old and retired, Zismann volunteers at Tucson Medical Center. She was a patient here about a year ago, and was invited to be a patient advocate during what’s called a “kaizen.”  It’s a rapid-improvement workshop made up of about a dozen leaders from different departments who set out to tackle a very specific issue. The meeting is a crucial process of TMC’s journey to a Lean culture, which produces patient-focused, reliable, safe and compassionate care through continuous improvement and the purposeful use of our resources.

The challenge of this particular kaizen: improving glycemic management for TMC patients with type 1 diabetes and keeping them from having multiple hypoglycemic, or low blood sugar, events during their stay. For three days, members from pharmacy, dietary, and the diabetes educators, among others, dug into how to provide better care for these patients. “Every time an idea was pitched, we’d run it by Marjorie to get the patient perspective,” said Pat Ledin, a member of the TMC Lean Team, which organized the kaizen. “We’d ask her, ‘Would that help you? Would that offend you?  How would that make you feel?’ We can’t stress how important it is for us to hear the voice of our patients and involve them in every change and process improvement.”

The visual cue that was created to alert staff to patients at risk for hypoglycemic episodes

The visual cue that was created to alert staff to patients at risk for hypoglycemic episodes

Some improvements were made immediately, including educating the medical staff who are on the front lines. Special signs were created and placed on the doors of patients with diabetes to serve as a reminder to staff that a patient is at risk for hypoglycemia.  Finger sticks are done on a more consistent basis, which allows for more coordination with meal times. Pre-packaged “snack attacks” are readily available for when patients do have an episode. “These have the right number of carbohydrates and protein, so it’s the perfect snack for this type of patient. It’s bulletproof,” said Ledin. Supply kits have been streamlined, there is a standardized approach to what staff does with a patient’s medication, and there is more consistency in how these patients are cared for among different departments.

One thing the team found may be contributing to more hypoglycemic events – TMC’s On Demand Room Service, which allows patients the flexibility to call in their meals whenever they’d like. It’s without a doubt improved overall patient satisfaction scores, but for those with hypoglycemia, it can add confusion about appropriately coordinating meal times. TMC Lean Team leader Cheryl Young explains, “On Demand doesn’t work for these people because their insulin is associated with their mealtime. If they eat at 9 a.m. for example, and want to eat again at 11 a.m., our On Demand service allows them to do that. But if they do, it could cause a hypoglycemic event because the meals are too close together. It’s best to have at least four hours in between meals. So we’re educating these patients that although we have this service, it’s not necessarily the best thing for them and their disease.”  Another little nugget of information that Zismann has found invaluable at home.

“As a result of this kaizen, we now have a standardized approach for the food, medication, education and visuals for these patients,” said Young.

Just one month later – dramatic results.  “With these patients, their disease process causes the hypoglycemic event to happen. But now we are seeing the repetitious events minimized during their stay here, which is a direct result of the improvements put into place from the kaizen,” said Ledin.

Zismann said she learned more about her disease during those three days than she had since her diagnosis more than a decade ago. She discovered TMC has diabetes educators who are available to help patients. “For me, the most frustrating thing has been to try and figure out what I’m supposed to be doing,” said Zismann. “TMC Diabetes Educator Nancy Klug was tremendous. She opened my eyes to the fact that I CAN eat certain foods, I just can’t eat much of them. I left her office feeling so empowered, and relieved that I really didn’t need to be so restrictive!”

Zismann admits she still has a long way to go before fully understanding her disease, but calls the opportunity to join that kaizen “one of the best things that’s ever happened to her.” “I felt like part of the group,” she said. “These people care. They come up with wonderful ideas. They work well together. It was unbelievable to watch them, and I have learned so much from the experience.”

While Zismann is applauding their efforts, the kaizen team leaders insist they’re the ones who were fortunate to have her there.  “We were able to collectively come to better decisions that have already led to better outcomes for our patients because of what Marjorie brought to this process as both a patient and a volunteer,” said Young.  “I think she absolutely gained as much as she gave.”

If you are interested in acting as a patient adviser for a particular department or issue, please contact Angie Bush at (520) 324-5512 or Angie.Bush@tmcaz.com.

To contact a TMC Diabetes Educator, please call (520) 324-3526.

Rosemary Duschene: Bariatric surgery and hard work lead to a new life

RosemaryRosemary Duschene had grown weary of her diabetes – and along with it, her daily regimen of multiple pills, multiple shots and multiple complications.

“I happened to catch a commercial that said bariatric surgery improves the diabetic condition,” she said.  “I had been a diabetic for 25 years, and it was just becoming totally unbearable.”

With support from her physicians and loved ones, she underwent the surgery just over a year ago, and now reports her diabetic regimen is down to just one pill per day – with the hope that even that one last pill could become unnecessary.

“Within one year’s time I lost 65-70 pounds,” Duschene recalled, noting the lifestyle change was “really not so difficult!  TMC made certain everything was perfect before I became a candidate for surgery.”

After the bariatric surgery to assist her weight loss, she was quickly back on her feet and active. “I wasn’t used to sitting around, and now I had all this added energy and less weight to carry around, so it was easy to get up and move.”

She had a dog to walk, so that was a great motivator – but the biggest energy stimulus has to be Duschene’s 2-year-old grandson, always ready for a trip to the park.

“I let him run, and he chases me, and I chase him…I want so much to be a part of his life.  It’s hard to keep up with a 2-year-old, but it isn’t so bad any more!  I don’t get so tired. It’s just really great to feel so good.”

Amputation as a last resort – How TMC’s Save A Limb program is saving lives

It is no secret that we live in a region where diabetes is rampant.  Statewide, the statistics are stunning.  According to the American Diabetes Association, one out of every nine Arizonans – nearly 500,000 people – are affected by the disease.

One of the most devastating consequences of the disease is amputation, and with more than 60 percent of non-traumatic lower-limb amputations occurring in people with diabetes, it is a common complication. And it doesn’t stop there with the loss of a limb; mortality rates increase with amputation.

Vascular surgeon Dr. Matthew Namanny, Saguaro Surgical

Vascular surgeon Dr. Matthew Namanny,
Saguaro Surgical

The goal of TMC’s Limb Salvage Team is to “save a limb, save a life.”  They work to keep these patients functional.  TMC’s Save A Limb program is a multidisciplinary approach to patients with advanced vascular disease or Peripheral Artery Disease (P.A.D.).  A team of vascular and podiatric surgeons, nurses, technicians and registered dieticians coordinate their care to save limbs and prevent amputations.  “The surgeons on this team are considered experts in this area,” explained Dr. Matthew Namanny, a vascular surgeon with Saguaro Surgical.  “If patients are suffering from severe P.A.D. or wounds, or if these patients are identified by physicians and nurses in hospitals and clinics, we want them sent here so that we can do everything possible to prevent that amputation.  That’s what we want to be known for.”

The team uses the most advanced methods available to treat patients, like rapid endovascular interventions, synthetic skin substitutes and prophylactic elective surgery to eliminate biomechanical foot abnormalities.

“We have a prevalent Native American population here, and a lot of our population is at high risk for P.A.D. because of obesity, coronary artery disease, and hypertension.  Having the Save A Limb program available at a community hospital is such a huge benefit to patients in Southern Arizona as well as the rest of the state.  Our team helps hundreds of patients a year, but we know there are hundreds more who could benefit, ” Dr. Namanny said.

For more information about TMC’s Save A Limb program, please click here.

Rigorous study confirms what TMC bariatric surgeons preach about surgery benefits for diabetics

A recent study done at the University of Minnesota and published in the Journal of the American Medical Association suggests bariatric surgery is a more effective way to reduce and even reverse diabetes than medication and lifestyle changes.  The findings, which came from one of the most rigorous studies of its kind, could lead to changes in who qualifies for the surgery.

Dr. Scott Welle TMC Bariatric Surgeon

Dr. Scott Welle
TMC Bariatric Surgeon

TMC Bariatric Surgeon Dr. Scott Welle said the research corresponds with exactly what he and other bariatric surgeons have said all along – that weight loss surgery is an effective tool for getting diabetes under control and even having it go into remission.  “It’s a lot more common for people to come into my office saying they want to get off their diabetes medicine rather than wanting to lose the weight.  Losing the weight is just the bonus.”  Type 2 diabetes affects more than 20 million Americans.  Most of these patients are overweight or obese, and are at a higher risk for heart disease and stroke, among other things.  Diabetes that is not controlled properly can damage the kidneys, eyes and blood vessels.

The yearlong study indicated that gastric bypass, the most common bariatric surgery in which the stomach is stapled to create a small pouch and attached to a lower part of the intestines, can effectively treat diabetes in patients who are considered mild to moderately obese.  “We’re finding this especially true for patients with a lower BMI, who are about 50 to 70 pounds overweight.  Our overall success rate is more effective with this patient population typically because they haven’t been diabetic as long as patients who are morbidly obese,” said Dr. Welle. 

To qualify for weight loss surgery outside of a research institution, a patient must have a BMI of at least 35, and a comorbid condition like diabetes, hypertension, or sleep apnea.  That magic number, 35, Dr. Welle explained, was recommended from the National Institutes of Health in the early 1990’s.  Newer research, which looks at treating people with a lower BMI, may lead to updated recommendations if the surgery is proven to be safe and effective.

“We’re starting to see these patients when they just barely qualify for surgery based on their BMI.  They’re coming in when they’re 80 to 100 pounds overweight, for example, wanting to get off their diabetes medication rather than waiting until they’re 300 pounds overweight,” he said.

Even then, Dr. Welle said, he and his team are not quick to operate.  “It’s not like diabetic patients come into our office, and we schedule a surgery date.”  The amount of time from the consultation to the actual surgery day can range from two to eight months.  There is a pre-authorization and pre-screening process.  Patients are given a psychological evaluation, and undergo nutritional counseling.  The pre-op workup is intense.  Plus, by the time a patient even hits his door, they’ve typically put considerable thought into their decision.  “Nine times out of ten, someone who presents for bariatric surgery has been thinking about it for at least five years on average,” he said. 

clip_image002Since 2011, TMC has been a Bariatric Center of Excellence, an accreditation from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP).  All bariatric surgeries performed at TMC are minimally invasive, and some are even done using the da Vinci surgical robot.  Dr. Welle said the surgery requires a one-to-two-day hospital stay,  and oftentimes patients are off their diabetes medication by the time they are discharged.  “Yes, it happens that quickly with metabolic procedures like gastric bypass.  A majority of my patients leave the hospital off their diabetes medication.”  Most patients resume their normal lifestyle in one to two weeks.

The study did mention an alarming complication rate.  About a third of the 60 adults who underwent gastric bypass developed serious problems within a year of the operation, although some cases were not directly linked to the surgery.  For more serious complications, including infections, intestinal blockages and bleeding, the rate was six percent. 

“If you look at the study, the number of people who had a complication in the surgery group was 22 out of 60.  If you look at the non-surgical group, 15 of those 60 people also had a complication.  It’s important to realize that no deaths were reported.  So when we say bariatric surgery is safe and effective, it truly is.  When you see high complication rates like this in a study, you need to really delve in and look at how strict they’re classifying their complications,” Dr. Welle said.  Patients in the surgery group ended up using an average of three fewer medications than patients in the non-surgical group.  “That’s medications for diabetes, high blood pressure, and high cholesterol.  It’s not just diabetes, rather the gamut of the metabolic syndrome that can be treated effectively with bariatric surgery,” Dr. Welle explained.

For more information about TMC’s Bariatric program, please click here.

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.

New Hyperbaric Chamber at TMC’s Wound Care Center

As diabetes continues to be on the rise, the need for comprehensive wound care also continues to grow in Tucson. In addition, the rising obesity epidemic and aging population will also contribute to the rising incidence of chronic wounds.

It was this obvious need that originally drove Tucson Medical Center to open an advanced wound care center in March of this year at its El Dorado Health Campus. When it opened, the 4,700 square-foot facility was equipped with two new hyperbaric chambers and five treatment rooms.

Since its opening, the center has experienced a flood of new patients and a rapid increase in procedures conducted.  In March the center completed 192 procedures, followed by 793 in July, and over 1056 in August.  As a result, the Wound Care Center is adding a third hyperbaric chamber to the facility.

Hyperbaric chambers help heal wounds by providing oxygen to the bloodstream and helping the patient heal from within.

What sets these chambers apart from others is their size.

“The reason why the size of a chamber is important is because a patient may spend as much as 2-2 ½ hours a day, five days a week, for six to eight week sessions in these enclosures. These chambers provide a comfort that is second to none and does not compare to smaller chambers,” explains Suzanne Pinon-Martinez, Program Director.

“The new chamber will allow TMC’s Wound Care Center to meet the increasing demand of this kind of treatment in the Southern Arizona community,” says TMC Chief Operations Officer Linda Wojtowicz.

In addition to hyperbaric treatments, the Wound Care Center also performs the employs the latest methods in skin substitute and debridement procedures.  It is one of more than 500 Healogics facilities staffed with highly trained physicians and clinicians who treat chronic wounds through a multidisciplinary approach and advanced treatments.

“We are truly on the breaking edge of wound care technology,” notes Pinon-Martinez.

Multidisciplinary Team Approach Saves Limbs of Diabetic Patients

Amputation is one of the most devastating consequences of diabetes. In fact, more than 60 percent of non-traumatic lower-limb amputations occur in people with diabetes, and one diabetes-related amputation occurs in the world every 30 seconds. In addition, mortality ratesincrease with amputation. TMC’s goal is to “save a limb, save a life,” says Karen Reinhard, NP, a member of TMC’s Limb Salvage Team.

Patients with diabetes often suffer foot problems because of myriad complications. Poor circulation and nerve damage lessen the body’s ability to feel pain in the foot or detect injuries. Even tiny cuts or ingrown toenails, left untreated, can cause serious tissue damage that may require amputation.

TMC’s Limb Salvage Team began last December and is comprised of vascular and podiatric surgeons, nurses, technicians and registered dieticians available to all patients with a lower-extremity ulceration. This combination of specialties arises from the concept of “toe and flow,” in which podiatric surgeons manage the non-vascular issues of the foot, and vascular surgeons perform the necessary measures to ensure adequate circulation for healing.

The team utilizes cutting edge methods such as rapid endovascular interventions, synthetic skin substitutes and prophylactic elective surgery to eliminate biomechanical foot abnormalities.

“I am incredibly pleased that we’ve developed a team of professionals who have been successful in preventing amputations in these patients,” says Dr. Gulshan Sethi, Section Chief of Cardiothoracic Surgery. “You need a vascular surgeon who can evaluate blood flow and find out if there is a blockage. Many of these patients – 60 to 70 percent – have cardiovascular disease. There is not enough blood flow to make an ulcer heal.”

“Losing a limb is not only a major limitation to a patient, it’s functionally devastating,” Sethi says. “We can do a better job. Doctors tell their patients what they need to do to improve, but if we have a team of people seeing the patient together in a combinedclinic, it can be very strong.”


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