Diabetes

Saint Luke’s Diabetes & Endocrinology Centers offer a highly specialized team to help guide patients along a course of treatment that is right for each individual.

Our comprehensive diabetes and endocrinology care includes:

  • Diabetes Self-Management Training by certified diabetes educators, recognized by the American Diabetes Association
  • Treatment of diabetes for patients of all ages
  • Advanced treatments for patients with thyroid disease, osteoporosis, and pituitary tumors
  • Direct access to specialty services, including:
    • Cardiology
    • Podiatry
    • Weight-loss surgery

Resources for People with Diabetes

Resources for People with Diabetes

Living with diabetes means making many changes in your life, and these changes may seem overwhelming. That’s a normal reaction. When you feel down, reach out to your family and friends. Your healthcare team is also there when you have questions or need advice.

How to help yourself

Tips for taking care of yourself include the following: 

  • Do things that you enjoy, like seeing a favorite movie, reading a good book, or listening to music.

  • Call a good friend just to chat.

  • Take a walk or do some gardening. Physical activity can relieve stress and lift your mood.

  • Stick to your treatment program. Keeping your blood glucose in your target range will help you feel better.

  • If you feel your plan isn't working for you, is too cumbersome, or is too expensive, discuss this with your healthcare providers. 

How to get help from others

Tips for getting help include the following: 

  • Talk to your friends and family about how you’re feeling. Give them information, like this health sheet, to help them understand more about diabetes.

  • Invite a family member to join you at your next appointment with your diabetes support team so they can learn ways to help support you. 

  • Join a diabetes support group. Support groups let you talk to other people with diabetes and share concerns, experiences, and tips for solving problems.

  • Your local library, community center, church group, senior center, or hospital may have information about support groups in your area.

  • Some healthcare organizations support Internet-based “chat groups.”

Resources

These organizations provide information, educational programs, and other services. They are there to help you.

  • American Diabetes Association

    800-342-2383

    www.diabetes.org

  • National Diabetes Information Clearinghouse

    800-860-8747

    www.diabetes.niddk.nih.gov

  • American Heart Association

    800-242-8721

    www.heart.org

  • Academy of Nutrition and Dietetics

    www.eatright.org

  • Juvenile Diabetes Research Foundation

    www.jdrf.org

Talk with your healthcare provider if you’re feeling helpless or hopeless or are having trouble sleeping or eating. These may be symptoms of depression, a serious but treatable problem.

Type 1 Diabetes

What is type 1 diabetes?

In type 1 diabetes, the body can’t make insulin. Insulin is needed to help glucose enter cells for energy. Without insulin, glucose builds up in the blood. This causes high blood glucose or high blood sugar. Type 1 diabetes may also be known as:

  • Insulin-dependent diabetes mellitus (IDDM)
  • Juvenile diabetes
  • Brittle diabetes
  • Sugar diabetes

Type 1 diabetes accounts for 5% of all diagnosed cases of diabetes in the U.S. Type 1 diabetes most often develops in children or young adults, but can start at any age.

What causes type 1 diabetes?

The cause of type 1 diabetes is unknown. It’s thought that genetic and environmental factors are involved.

The body's immune system attacks and destroys the cells in the pancreas that make insulin. Insulin lets glucose to enter the cells for energy. When glucose can’t enter the cells, it builds up in the blood. This deprives the cells of nutrition. It also results in high blood sugar. People with type 1 diabetes must take daily insulin shots and regularly check their blood sugar levels.

What are the symptoms of type 1 diabetes?

Type 1 diabetes often appears suddenly. Symptoms may include:

  • Unusual thirst
  • Frequent passing urine
  • Extreme hunger but loss of weight
  • Blurred vision
  • Nausea and vomiting
  • Extreme weakness and fatigue
  • Irritability and mood changes

In children, symptoms may be similar to those of having the flu.

The symptoms of type 1 diabetes may look like other conditions or health problems. Always see your healthcare provider for a diagnosis.

How is type 1 diabetes diagnosed?

There are several ways to diagnose diabetes. It is best for the tests to be repeated on a second day to make sure of the diagnosis.

  • A1C.  The hemoglobin A1C test measures your average blood glucose for the past 2 to 3 months. Diabetes is diagnosed at an A1C of greater than or equal to 6.5%.
  • Fasting plasma glucose (FPG). This test checks your blood glucose levels after fasting overnight. You may have water before this test is done, but nothing else. Diabetes is diagnosed at a fasting blood glucose of greater than or equal to 126 mg/dl.
  • Oral glucose tolerance test (OGTT).  This is a 2-hour test that checks your blood glucose levels before and 2 hours after you drink a sugary drink. This test tells your doctor how your body processes glucose. Diabetes is diagnosed at a 2-hour blood glucose of greater than or equal to 200 mg/dl.
  • Random glucose test. This blood test is done at any time of the day. Diabetes is diagnosed at blood glucose of greater than or equal to 200 mg/dl with the symptoms of hyperglycemia or hyperglycemic crisis.
  • Insulin and c-peptide levels. Levels of these will be low or normal with type 1 diabetes, but high with type 2 diabetes.
  • Antibody levels. People with newly diagnosed type 1 diabetes will usually have high levels of antibodies against certain proteins found in the pancreas.

How is type 1 diabetes treated?

Your healthcare provider will figure out the best treatment based on:

  • How old you are
  • Your overall health and medical history
  • How sick you are
  • How well you can handle specific medications, procedures, or therapies
  • How long the condition is expected to last
  • Your opinion or preference

If you have type 1 diabetes, you will need daily shots of insulin to keep your blood sugar level in normal ranges. Other parts of treatment may include:

  • Eating a diet to help manage blood sugar levels
  • Exercising to help the body use blood sugar efficiently
  • Monitoring blood sugar levels several times a day, as directed by your healthcare provider, and learning how to adjust your meals and insulin dose accordingly.
  • Having regular hemoglobin A1C testing. This is recommended at least twice a year or more often if your blood sugar level stays too high.

Research is underway to find better ways to manage diabetes. This includes looking for other way to take insulin such as through inhalers, pills, or pumps. Researchers have also identified some genetic markers for type 1 diabetes. Pancreas and islet cell transplants are considered experimental treatment.

What are the complications of type 1 diabetes?

Type 1 diabetes may cause the following:

  • Hypoglycemia. This is low blood sugar, sometimes called an insulin reaction. It occurs when blood sugar drops below 70 mg/dl, usually when the previous insulin dose was too high.
  • Hyperglycemia. This is high blood sugar that occurs when the body has too little insulin. It can be a sign that diabetes is not well controlled.
  • Ketoacidosis. When your body doesn't have enough insulin to use glucose for energy, it creates ketones. Ketones are a chemical that breaks down fats for energy. When ketones build up to high levels, it is a life threatening condition which can lead to coma or death.
Long-term complications of uncontrolled type 1 diabetes include:
  • Heart disease
  • Kidney disease
  • Eye problems
  • Nerve problems
  • Foot problems

Key points

  • Type 1 diabetes is an immune system disorder in which the body's immune system destroys, or tries to destroy, the cells in the pancreas that make insulin.
  • When glucose can’t enter the cells, it builds up in the blood. This deprives the cells of nutrition.
  • For type 1 diabetes, you need daily insulin injections. You also need to regularly check your blood sugar levels.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.

Type 2 Diabetes

What is type 2 diabetes?

Type 2 diabetes is when your body can’t make enough insulin, or use it well. Insulin helps your cells use sugar (glucose) for energy. Without insulin, glucose builds up in your blood. This leads to high blood sugar.

Type 2 diabetes is a chronic disease. It has no known cure. It is the most common type of diabetes.

What causes type 2 diabetes?

The exact cause of type 2 diabetes is not known. It seems to run in families. But it often takes other factors to bring on the disease. These include:

  • Being overweight
  • Not getting enough physical activity
  • Taking certain medicines

Who is at risk for type 2 diabetes?

Risk factors include:

  • Age. People ages 45 and older are at higher risk for diabetes.
  • Family history of diabetes. The condition tends to run in families.
  • Extra weight. Being overweight puts you at higher risk.
  • Lack of exercise. Not enough physical activity also puts you at risk.
  • Taking certain medicines. These include steroids, some diuretics, and antipsychotics.
  • Race and ethnicity. People who have African, Hispanic, Asian, Pacific Island, or American Indian heritage are more likely to develop type 2 diabetes.
  • Gestational diabetes. Having diabetes in pregnancy puts you at higher risk of type 2 diabetes later.
  • Large baby. Giving birth to a baby over 9 pounds puts you at risk.
  • Low HDL. This means low levels of the "good cholesterol."
  • A high triglyceride level. This is a type of blood fat.
  • Smoking. Being a smoker puts you at higher risk.
  • Other health conditions. Some conditions are linked with type 2 diabetes. These include polycystic ovary syndrome, acanthosis nigricans (patches of darker skin), or being born at a low birth weight.

What are the symptoms of type 2 diabetes?

Symptoms may include:

  • Frequent bladder infections
  • Skin infections that don't heal easily
  • Excess thirst
  • Peeing often
  • Weight loss
  • Blurred vision
  • Nausea and vomiting
  • Extreme weakness and fatigue
  • Irritability and mood changes
  • Dry, itchy skin
  • Tingling or loss of feeling in the hands or feet

Some people who have type 2 diabetes don’t have symptoms. Symptoms may be mild and you may not notice them. Half of all Americans who have diabetes don't know it.

The symptoms of type 2 diabetes may be like other health problems. Seeee your healthcare provider for a diagnosis.

How is type 2 diabetes diagnosed?

Diabetes can be diagnosed with several tests. It is best to repeat the tests a second time to confirm the results. The tests include:

  • A1C. This is the hemoglobin A1C test. It measures your average blood glucose for the past 2 to 3 months. An A1C of 6.5% or higher means you have diabetes.
  • Fasting plasma glucose (FPG). This test checks your blood glucose levels after 8 hours of fasting. You usually get this test before your first meal of the day. This is called your fasting blood glucose level. A result higher than or equal to 126 mg/dl means you have diabetes.
  • Oral glucose tolerance test (OGTT). For this test, your glucose level is measured before and then after 2 hours after you drink a sugary drink. This shows how well your body processes glucose. A result of 200 mg/dl or higher after 2 hours means you have diabetes.
  • Random glucose test. This blood test is done at any time of the day. Blood glucose of 200 mg/dl or higher with symptoms of high blood sugar means you have diabetes.

How is type 2 diabetes treated?

Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is.

The goal of treatment is to keep blood sugar levels as close to normal as possible, but not too low. To do this, you will need to control your blood sugar. You will need to check it regularly.

You may be able to control your type 2 diabetes with weight loss, exercise, and healthy eating habits. But you may also need to take medicine or insulin.

Treatment may include some or all of these:

  • Being more active. Get at least 150 minutes a week of exercise or physical activity. Don’t let more than 2 days go by without being active. When sitting for long periods of time, get up for light activity every 30 minutes.
  • Meal planning. You will need to eat foods that don’t cause your blood sugar to rise too quickly. Your healthcare provider will give you resources about what foods to plan your meals around.
  • Weight loss. Losing just 5% to 7% of your body weight can help. Talk with your healthcare provider about ways to help you lose weight.
  • Taking medicine. There are different types of medicines to treat type 2 diabetes. Each type works in a different way to lower blood sugar. You may take one or more medicines to improve your blood sugar control.
  • Taking insulin. If oral medicines don’t work well for you, you may need to inject insulin into your body.
  • Getting blood tests. You will need to have your A1C level checked several times a year. Experts advise testing at least twice a year if your blood sugar level is in the target range and stable. You will need this test more often if your blood sugar level is not stable.
  • Routine healthcare. Keep all appointments. This is so your healthcare provider can track your diabetes. You will also need to check your feet daily. This is to look for sores or infection. These can lead to severe foot problems.

What are possible complications of type 2 diabetes?

Diabetes that is not treated or controlled well can cause problems. These can include problems with:

  • Kidneys
  • Legs
  • Feet
  • Eyes
  • Heart
  • Nerves
  • Blood flow

This can lead to:

  • Heart failure
  • Kidney failure
  • Gangrene
  • Amputation of feet
  • Blindness
  • Stroke

For these reasons, it is important to follow a strict treatment plan.

Key points

  • Type 2 diabetes is when your body can’t make enough insulin, or use it well.
  • Insulin helps the cells in your body absorb glucose for energy. Without insulin, too much glucose is left in the blood. This causes high blood sugar.
  • Type 2 diabetes is a chronic disease. It has no known cure. It is the most common type of diabetes.
  • The exact cause of type 2 diabetes is not known. It tends to run in families.
  • Diabetes that is not treated or controlled can lead to serious health problems.
  • The goal of treatment is to keep your blood sugar levels as close to normal as possible, but not too low. You will need to control your blood sugar. You will need to get physical activity, plan meals, and get regular healthcare.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.

Gestational Diabetes

What is gestational diabetes?

Gestational diabetes is a type of diabetes that happens during pregnancy. Unlike type 1 diabetes, gestational diabetes is not caused by having too little insulin. Instead a hormone made by your placenta keeps your body from using the insulin as it should. This is called insulin resistance. Blood sugar (glucose) then builds up in your blood instead of being absorbed by the cells in your body.

The symptoms of gestational diabetes usually go away after delivery. But sometimes they do not, or you may have a greater risk of developing type 2 diabetes later.

What causes gestational diabetes?

Healthcare providers do not know what causes gestational diabetes, but they do know what happens.

The placenta gives your growing baby nutrients and water. The placenta also makes several hormones to keep the pregnancy healthy. These hormones include:

  • Estrogen
  • Progesterone
  • Cortisol
  • Human placental lactogen

These hormones can affect how your body uses insulin (contra-insulin effect). This usually begins about 20 to 24 weeks into your pregnancy and could lead to gestational diabetes.

During pregnancy, more fat is stored in your body, you take in more calories, and you may get less exercise. All of these things can make your blood sugar (glucose) levels higher than normal and possibly lead to gestational diabetes.

As the placenta grows, it makes more of the hormones. The risk for insulin resistance becomes greater. Normally your pancreas is able to make more insulin to overcome insulin resistance. But if it cannot make enough to overcome the effects of the placenta’s hormones, you can develop gestational diabetes.

Who is at risk for gestational diabetes?

Any woman can develop gestational diabetes during pregnancy. But you may be more likely to get it if you:

  • Are overweight or obese
  • Have a family history of diabetes
  • Are older than 25
  • Are African American, American Indian, Asian American, Hispanic or Latino, or Pacific Islander
  • Have prediabetes (impaired glucose tolerance)
  • Have high blood pressure

 

What are the symptoms of gestational diabetes?

Gestational diabetes does not cause any symptoms. That’s why it’s important to get tested for it if you are at high risk.

If your blood sugar levels are very high, you may have these symptoms:

  • You urinate more than normal
  • You are hungrier or thirstier than normal.
  • You have blurred vision
  • You have nausea and vomiting
  • You lose weight even though you are hungrier

How is gestational diabetes diagnosed?

You should be tested for gestational diabetes in your 24th to 28th week of pregnancy.

The American Diabetes Association also recommends that you be tested for type 2 diabetes if you have risk factors for this condition. This testing should be done at your first prenatal visit.

Screening is done by these tests:

  • One-hour glucose tolerance test. You drink a special beverage high in sugar. One hour later, the healthcare provider measures your blood sugar (glucose) levels. If your levels are higher than a certain level, this is considered an abnormal result.
  • Three-hour glucose tolerance test. If the 1-hour test is abnormal, you will have a second glucose tolerance test done to confirm the diagnosis. You will drink another special beverage, but with more sugar. Your healthcare provider will measure your blood sugar levels 1 hour, 2 hours, and 3 hours later. You have gestational diabetes if at least two of the glucose measurements are higher than normal.

If you are diagnosed with gestational diabetes, you should get tested for diabetes 4 to 12 weeks after your baby is born. You should also get this screening at least every three years for the rest of your life.

What is the treatment for gestational diabetes?

Your healthcare provider will figure out the best treatment for you based on:

  • How old you are
  • Your overall health and past health
  • How sick you are
  • How well you can handle specific medicines, procedures, or therapies
  • How long the condition is expected to last
  • Your opinion or preference

Treatment for gestational diabetes focuses on keeping your blood sugar levels in the normal range. Treatment may include:

  • Special diet. You should eat 5 servings of vegetables, fruits, low-fat or nonfat dairy products, and lean meats. Use liquid fats for cooking instead of solid fats. You should eat whole grains and avoid high-calorie snacks or sweet desserts.
  • Exercise. You should do moderate exercise unless your healthcare provider tells you not to.
  • Daily blood glucose monitoring. Your goal is to keep your blood sugar levels lower than 130mg/dL to 140mg/dL one hour after eating.
  • Insulin injections. You may need these to control your blood sugar levels. Or you may need other medicines taken by mouth.

What are the complications of gestational diabetes?

Gestational diabetes usually does not cause birth defects. But it can affect your baby in other ways if your blood sugar levels are not under control.

Below are the two major health problems that can develop.

Macrosomia

Macrosomia means a baby who is much larger than normal. This happens if the mother’s blood has too much blood sugar in it. The fetus’ pancreas senses this high level of blood sugar and makes more insulin. The fetus then changes the extra blood sugar into fat. This extra fat means a larger baby.

A larger than normal baby can be difficult to deliver. The baby may have trauma or nerve damage, or need to be delivered by cesarean section.

Hypoglycemia

Hypoglycemia is low blood sugar. This can happen to the baby just after he or she is born if the mother’s blood sugar levels are too high. The high levels in the mother cause the fetus to make more insulin. Once the baby is born, he or she no longer has the high blood sugar levels from the mother. This causes the baby’s blood sugar levels to fall very low.

Your blood sugar levels will be watched very closely during labor. Your healthcare provider may give you insulin to keep your blood sugar in a normal range. This will prevent your baby's blood sugar from dropping greatly after delivery. 

Babies born to mothers with gestational diabetes may also have low levels of calcium or magnesium in their blood.

These complications can be prevented. The key to prevention is careful control of your blood sugar levels just as soon as the diagnosis of diabetes is made.

Key points about gestational diabetes

  • Gestational diabetes is a type of diabetes that happens during pregnancy.
  • It may be caused by the hormones made by your placenta. These hormones can make insulin in your body not work as well as it should.
  • Gestational diabetes happens about halfway through pregnancy and does not cause birth defects.
  • If your blood sugar is not under control, your baby can develop problems. One problem is larger growth than normal. The other problem is very low blood sugar just after birth.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.

News

FOX4: New approach takes insulin, risk of heart problems out of Type 2 Diabetes treatments
A different way of treating patients with Type 2 Diabetes takes away the insulin and it also takes away much of the threat of heart problems for patients.
FOX4: Saint Luke's doctors fighting misconception that women with Type 1 diabetes can’t have children
It's a misconception doctors at Saint Luke's Maternal-Fetal Medicine Specialists are fighting for women with Type 1 diabetes hoping to become mothers, and it might just give you some hope.  

Providers

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Brian Todd Allenbrand, MD

Endocrinology, Diabetes, and Metabolism
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Amanda Megan Bell, MD

Endocrinology, Diabetes, and Metabolism
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Bhavika Bhan, MD

Endocrinology, Diabetes, and Metabolism
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Marie L Griffin, MD

Endocrinology, Diabetes, and Metabolism
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Mitchell S Hamburg, MD

Endocrinology, Diabetes, and Metabolism
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Jeffrey D Kallsen, MD

Endocrinology, Diabetes, and Metabolism
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Renato Mendoza Sandoval, MD

Endocrinology, Diabetes, and Metabolism
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Dorota J Walewicz, MD

Endocrinology, Diabetes, and Metabolism

Saint Luke's Endocrinology Specialists

Saint Luke's Endocrinology Specialists treat conditions including diabetes (type 1, type 2, and gestational) and thyroid disease.