VOLUME X ISSUE 1
HouseCall
UNDERSTANDING DIABETES
UNDERSTANDING
DIABETES
WHAT YOU SHOULD KNOW
2 I HouseCall I Volume X Issue 1
There is simply no way to gloss over it: getting a diagnosis of diabetes is tough. Diabetes is a serious, complex, chronic, and progressive condition and there is no cure for it. It demands a great deal of discipline and lifelong medical care to keep it under control and prevent its many complications. That’s the reality. But there is a positive side: those who learn to manage their disease can live well with it, enjoying good health, full lives and longevity. Fortunately there are countless resources available to help people successfully make the transition to living with diabetes, including many at St. Clair Hospital. t St. Clair, a multidisciplinary team of highly
attacks itself. People with Type 1 have to take insulin.
A
qualified diabetes experts are ready to help; they
Type 1 diabetes used to be called juvenile diabetes because
are internists, endocrinologists, pharmacists,
it is most often diagnosed in children, but adults can develop
dietitians, diabetes educators, as well as sub-
it, too. Type 2 diabetes means that the body does not use
specialists in cardiology, ophthalmology, obstetrics and
insulin well and cannot maintain the blood sugar within the
nephrology. According to St. Clair’s Wayne A. Evron, M.D.,
normal range. It develops more slowly and is more common
FAACE, who is board-certified in internal medicine and
in adults over 40. Type 2 is not an autoimmune disease;
endocrinology, “Our Diabetes Center has many program
95 percent of people with diabetes have Type 2. Gestational
options and excellent diabetes educators with a lot of
diabetes is a form of diabetes that occurs during pregnancy.
experience. St. Clair is a one-stop shop for diabetes
It is temporary but it can cause problems for the mother and
care and education.”
the baby, and it raises the risk of developing Type 2 diabetes
Diabetes mellitus affects the way the body turns food
later in life for both. Pre-diabetes is an intermediate type of
into energy to fuel physiologic functions. Normally, the
diabetes that progresses to Type 2; that progression can be
pancreas makes insulin, a hormone which acts like a key
prevented or delayed with lifestyle modifications.
that allows sugar to enter our cells. In diabetes, the body
There is a strong correlation between diabetes and
is not making enough insulin, or it is unable to properly
heart disease. Diabetes greatly increases the risk of heart
use insulin. When there isn’t enough insulin, or when the
attack and stroke, even when blood sugar levels are well
cells stop responding to insulin (insulin resistance), excess
controlled. According to the American Heart Association, at
sugar remains in the bloodstream and may cause serious
least 68 percent of people with diabetes who are 65 or older
and disabling health problems.
die of some form of heart disease; 16 percent die from
There are three main types of diabetes. according to
stroke. Adults with diabetes are two to four times more
St. Clair endocrinologist Douha Safar, M.D. Type 1 is an
likely to die of heart disease than adults who do not
autoimmune disease, meaning that the body mistakenly
have diabetes. Continued on page 4
OVER
30
MILLION
PEOPLE IN THE U.S. HAVE DIABETES
THAT’S OUT
1 OF 10 AMERICANS
1 OF 4 OUT
DON’T KNOW THEY EVEN HAVE IT
Source: Centers for Disease Control and Prevention (CDC)
Volume X Issue 1 I HouseCall I 3
UNDERSTANDING DIABETES Continued from page 3
A major public health problem
risk factors
Diabetes mellitus has been recognized as a disease since
for Type 2 diabetes
ancient times. As early as 1500 B.C., physicians wrote of “sweet urine disease,” but they had no insight into its causes. The diagnosis was made with the help of ants: if ants were attracted to a person’s urine, it was assumed that the urine was sweet. Primitive treatment consisted of hydration, but most of those afflicted died. It wasn’t until the end of the 19th century that progress was made in understanding diabetes. Today diabetes is one of the most prevalent diseases on the planet.
Family history of diabetes
Overweight
Consider these facts from the CDC: more than 30 million adults in the U.S. have diabetes, and one in four of them are unaware of it. More than 84 million adults, over a third of us, have pre-diabetes, and 90 percent don’t know it. In the last 20 years, the number of adults diagnosed with diabetes has more than tripled as the American population has aged and grown obese. Diabetes is the seventh leading cause of death in the U.S. and it costs over $245 billion annually.
Physical inactivity
Smoking
According to the American Journal of Preventive Medicine, if current trends continue, one in three Americans will have diabetes by 2050. The reasons for this are complex, but Dr. Evron cites obesity and the aging of the population as factors. “We’ve seen an exponential rise in diabetes in western Pennsylvania,” he says. “There are more people diagnosed in part because the definition was changed. A fasting blood sugar of 140 used to be the standard and it was decreased to 126. This was done because of the risk of complications.” Despite the data, it is not all doom and gloom, according to Adrian Vella, M.D., Mayo Clinic endocrinologist and Chair for Research in the Division of Endocrinology, Diabetes, Metabolism, and Nutrition at
Adrian Vella, M.D., Endocrinologist, Mayo Clinic
DOUHA SAFAR, M.D.
Mayo Clinic. The CDC’s 2017 Diabetes
Dr. Safar specializes in endocrinology. She earned her medical degree at the University of Aleppo, Aleppo, Syria. She completed an internship at The Pennsylvania State University College of Medicine and a fellowship at University of Pittsburgh School of Medicine. Dr. Safar is board-certified by the American Board of Internal Medicine. She practices with Associates in Endocrinology, P.C.
Report Card showed a decrease in the rate of new cases among
To contact Dr. Safar, please call 412.942.2140.
adults. “Most of the initiatives that would change this picture are at the public health level,” Dr. Vella says. “In 2017 we saw a flattening in new cases among adults. This is encouraging, but there are ongoing challenges. Diabetes is a major public health concern that requires preventive care programs to improve outcomes. It’s largely about patient education and the development of healthy habits. The American Diabetes Association and the American Heart Association have developed multiple joint programs to address the link between diabetes and heart disease. At Mayo Clinic, and at St. Clair and other members of the Mayo Clinic Care Network, we are working to integrate healthy living advice into all of our care.”
4 I HouseCall I Volume X Issue 1
Diagnosing the disease Camille M. Buonocore, M.D., a board-certified endocrinologist at St. Clair, says that for many of her patients, a diagnosis of diabetes confirms their worst fear. “For many, the diagnosis comes as a shock; for others, it may have been anticipated but is still upsetting. What helps is diabetes education and a trusting relationship with their physician. A relationship makes people more receptive to learning and taking action.” There are no remissions, no days off or vacations from diabetes — not without consequences. And, the worst consequences of uncontrolled diabetes can be dreadful: blindness, amputation, kidney failure and heart disease. It’s stressful, but people with diabetes learn to manage it and to live healthy lives when they understand their disease and make the modifications it requires. It can be a wake-up call that motivates them. “You can manage diabetes without losing your quality of life,” says Dr. Buonocore. “Simple things, like learning to read a food label, eating protein at every meal, and understanding the importance of portion size go a long way. Diabetes is doable: you have choices.”
“ ”
YOU CAN MANAGE DIABETES WITHOUT
LOSING YOUR QUALITY OF LIFE.
CAMILLE M. BUONOCORE, M.D., ENDOCRINOLOGIST, ST. CLAIR HOSPITAL Dr. Buonocore examines patient David Zebroski of McMurray.
minimize your risk
Eat healthfully
Be more active
Lose weight
Quit smoking
Get a check up
Volume X Issue 1 I HouseCall I 5
UNDERSTANDING DIABETES Continued from page 5
For the future: A focus on prevention Despite the gravity of diabetes and the challenges it poses for patients and physicians, great progress has been made in its treatment. St Clair’s Bridget K. Beier, D.O., who is board-certified in internal medicine and endocrinology, describes some of these advances: “New and more effective medications and technology are changing things. Continuous glucose monitoring (CGM) systems enable people to check their blood without a finger stick. There is a CGM system with an integrated insulin pump; it functions like an automatic insulin delivery system. There has been an enormous expansion of resources for diabetes education and support. Thanks to these advances, we are seeing a reduction in diabetes complications.” However, diabetes is an expensive disease, Dr. Beier says. “The cost of medications is a major issue, and there are few generics. Compliance with your regimen is essential to good diabetes management, but for many people, cost is a barrier to compliance.”
Dr. Evron examines patient Carla Roehner.
recognizing the signs of diabetes major complications if untreated, diabetes can cause serious complications, such as:
•• •• •• •• •• ••
Heart disease
Unusual weight loss
Extreme fatigue
Numbness or tingling in hands or feet
Vision loss Dental problems Kidney failure Nerve damage Loss of limbs
Increased thirst
6 I HouseCall I Volume X Issue 1
Frequent urination
Blurred vision
DIABETES COMPLICATIONS:
Dr. Beier envisions a future in which diabetes prevention is emphasized. “We definitely need to focus on prevention and increasing public awareness. Diabetes education makes a difference, but it is after the fact. Health insurance should reimburse for all diabetes education, including pre-diabetes prevention. I’d like to see pre-diabetes education in the schools. Obesity keeps getting younger and there are kids with pre-diabetes.”
serious but avoidable A
wareness of the potential complications of diabetes is an essential aspect of self-management. When diabetes is not well controlled and
blood sugar levels are high or erratic, there is a risk of developing
serious complications in many organ systems. Many of these complications are life-changing and disabling, and some may even result in death. In general, high blood sugar can damage the tiny blood vessels throughout the body. The
Sharing their stories
sugar “sticks” to these vessels, making them narrow; as a result, blood cannot
In these pages, HouseCall presents profiles of six adults who
flow freely through them to organs they supply. This happens most often in the
have each created their own unique way to live with diabetes.
eyes, nerves, lower limbs, kidneys and cardiovascular system.
Each was faced with navigating a new world, unexpectedly,
High blood sugar harms the tiny blood vessels in the eyes, causing
and they have done so with intelligence,
swelling of the vessel walls and leakage of fluid into the retina. This can lead
creativity and discipline. They are the
to blurred vision, vision loss and blindness. In addition, people with diabetes
embodiment of the resilient human
have a higher incidence of cataracts and glaucoma.
spirit that perseveres against
High levels of blood sugar damage the nerves so that they stop sending
daunting challenges.
essential signals between the brain and the body, including pain signals.
Hopefully, their stories
This is known as diabetic neuropathy, and it includes peripheral
will educate, encourage
neuropathy that affects the arms and legs. Peripheral neuropathy
and perhaps even
can cause pain, numbness or weakness.
inspire. n
There are several ways that feet are damaged by high blood sugar. Damage to blood vessels causes poor circulation so that sores and infections on the feet can’t heal. This can lead to amputations
Dr. Beier examines patient Mary Ann O’Neill of South Fayette.
of toes, feet and legs. Nerve damage prevents you from feeling the pain signals that tell you there is a problem. The nerve damage can also deform the feet, leading to pressure points that create sores. The kidneys, the vital organs that filter the blood, keep the good substances inside the body and discard waste products and excess fluid.
“
High blood sugar clogs the tiny blood vessels that fill the kidneys so that they gradually receive less blood and waste products build up. When the kidneys
WE DEFINITELY NEED TO FOCUS ON PREVENTION AND INCREASING
PUBLIC AWARENESS.
”
BRIDGET K. BEIER, D.O., ENDOCRINOLOGIST, ST. CLAIR HOSPITAL
fail, dialysis is necessary to filter the blood, and sometimes a kidney transplant is needed. High blood sugar, along with fat, builds up in the blood vessels that bring essential oxygen to the heart and brain. This can lead to a heart attack or stroke. As bad as this sounds, the complications of diabetes are preventable, says St. Clair Hospital Endocrinologist Wayne A. Evron, M.D. , FAACE. “The incidence of severe complications is way down due to better education, better medical management and self-care, and better drugs, including statins (used for controlling high cholesterol). The numbers are getting better and the dire consequences of diabetes are not as common. Amputations are entirely avoidable, as is blindness. Monitoring your blood sugar, keeping it as normal as possible and avoiding variability in your levels slows the onset and severity of complications.” n
Volume X Issue 1 I HouseCall I 7
UNDERSTANDING DIABETES Continued from page 7
A Patient’s Story
Maureen: A new way of life. Maureen Linkosky reaches high and grasps firmly. She is an achiever, a woman of many accomplishments: she is a highly skilled Physician Assistant to an orthopedic surgeon, assisting with as many as six to eight complex surgeries every day. She has a home and three children: Sara, Kate and John; she loves to travel; and she lives an active, healthful lifestyle. On Saturday mornings when the weather is nice, Maureen, 55, and her husband John can often be found on the “Jail Trail,” the segment of the Three Rivers Heritage Trail that runs parallel to the Monongahela River. It’s an activity that Maureen loves; it gets her outdoors and it provides great exercise. Biking also helps to keep her blood sugar stable and, for Maureen, that is a primary concern, as she has Type 1 diabetes.
“ ”
I was not going to be a victim. MAUREEN LINKOSKY, PATIENT
8 I HouseCall I Volume X Issue 1
When Maureen learned of her diagnosis 10 years ago, she was shocked. She had an autoimmune condition since childhood and, at 45, it had inexplicably attacked her pancreas, causing her to develop diabetes. “My first thought was, ‘Oh no!’ It’s a life-altering diagnosis and at first, it’s difficult to grasp,” she says. “But there was no time for ‘Woe is me’ — I told myself, this can be managed; I knew that I could have been handed something worse. Fortunately, I’ve had life experiences that gave me perspective; my husband had open heart surgery at 43. It came down to, what do I have to do? Watch what I eat, very carefully? Okay, I can do that. I had to accept a new way of life, not the end of my life.” Maureen accepted her diagnosis with poise and resolve. “I was not going to be a victim,” she explains. “The options are simple: do what you should or face dire consequences. I do exactly what my endocrinologist, St. Clair Hospital’s Camille M. Buonocore, M.D., tells me to do to keep
Type 1 diabetic Maureen Linkosky in the kitchen of her Mt. Lebanon home.
my blood sugar in control, including following a low carb/no carb eating plan. Dr. Buonocore is an expert in her field. She has compassion and empathy and listens well to her patients. This makes her a special provider and I’m glad that I found her.” Diabetes is complicated, but there are many resources to educate and support you, Maureen says. “I had the added benefit of my education
complications are far off. They can happen now. It’s essential to pay attention to what you eat. I cut my carbs in half and then in half again. I read labels. Protein goes into effect in four hours, carbs in two
as a health care professional. It helps me to remember that I’m needed;
hours, so if you eat carbs, you get hungry quickly. You have to learn how
people depend on me. I have to take care of myself for me, but also for
to choose the healthiest food: the difference between an orange and a
my family and others. It isn’t their problem, but it affects them because
clementine matters when you are diabetic.” Maureen loves to cook
it affects me.” Maureen did research and educated herself, but also took
and is creative in adapting her cooking to diabetes; steak Diane and a
advantage of the patient education offered by the Diabetes Center at
flourless chocolate cake are among her specialties. “I do everything I
St. Clair. “St Clair has a great program,” she says. “Their approach is,
did before, but now I tweak it. I have salad for lunch every day, but that
‘What do you need? How can we help?’ St. Clair is the only hospital that
doesn’t mean I just eat lettuce every day; I have variety and I put chicken
has a needle drop-off program; that may seem like a small thing, but
or seafood in the salad. I make skinny tacos — lettuce leaves make a
it makes a huge difference. It’s practical and it helps the community.”
great tortilla shell.”
There are some aspects of managing diabetes that can only come
Maureen’s work is demanding and strenuous, but deeply satisfying.
from experience, and Maureen has plenty of experience that she is
“In orthopedic surgery, we transform lives. We relieve pain and give
eager to share. For one thing, she says that there is a “street smart”
people back their mobility. Most of the patients do very well. At work,
aspect to living with diabetes. “Living with diabetes is nuanced. There
I am on the move all the time, and I had to figure out what works for me.
are many aspects to it; it’s like a science project sometimes, keeping
Your plan has to be individualized: when and what to eat and exercise;
everything in a state of balance. The practicalities are what matter
how to deal with stress, illness, travel and other things that impact
most. No one has time for extreme planning, so you have to make it
diabetes. The key is regular routines and nothing in excess.”
as simple as possible. If it’s simple, it’s easier to stick to it.”
Dr. Buonocore praises Maureen for her ability to maintain balance.
Whether she is spending her work day in the Operating Room,
“The best scenario is a very regular routine, and Maureen has done this
making rounds at a hospital or seeing patients in the office, her days
well. She is a highly motivated patient, plus she was already in excellent
begin early; she gets up at 4:30 a.m. and is at the hospital by 6:15.
health. Her diabetes is tightly controlled. Lifestyle is a major factor
As an orthopedic physician assistant, Maureen works with amputees
with Type 1 and Type 2 and simple changes go a long way. Eat balanced
on a regular basis and is well aware of the severe consequences of
meals and include protein at every meal; take your medication; and
uncontrolled diabetes. “Diabetes can get very bad very quickly; many
add exercise to your life. You can manage diabetes without losing your
people fail to understand this. You can’t let yourself think that
quality of life.” n
Volume X Issue 1 I HouseCall I 9
UNDERSTANDING DIABETES Continued from page 97
A Patient’s Story
Carla: Knowledge is power. Carla Roehner, 57, of Upper St. Clair, is devoted to her family, and now that her own two children are young adults, she is looking forward to the next life stage: being a grandmother. She wants to live a healthy lifestyle so she can enjoy the grandchildren that she is hoping for, and she is determined that her Type 2 diabetes will not be an obstacle. Carla always believed that she was probably going to get diabetes. Her mother, father and an aunt had diabetes before her, as did three of her grandparents. Carla had gestational diabetes with her second pregnancy, and sure enough, she was diagnosed at age 43 with Type 2 diabetes. She was able to manage her diabetes with diet and oral medications, under the guidance of John E. Popovich, M.D., her primary care physician, and she speaks with refreshing candor about her experience: “For a long time, my A1Cs (blood tests for sugar levels) were okay and I pretty much ate whatever I wanted and I felt fine. I didn’t give my diabetes a lot of attention.” But a few years ago, Carla had her first wake-up call, an A1C of 8.4, and Dr. Popovich decided it was time to see a specialist. Carla went to diabetes classes and began to exercise more; as a result, her A1C went down to 6.5. In subsequent blood work, however, she found her A1C gradually rising. She would increase her exercise and it would drop a bit. In the meantime, she decided to switch to a new
“
WE’RE GOING TO WORK HARD AT THIS.
HELP ME HELP YOU.
”
WAYNE A. EVRON, M.D., FAACE, ENDOCRIOLOGIST, ST. CLAIR HOSPITAL
Wayne A. Evron, M.D., FAACE
WAYNE A. EVRON, M.D., FAACE Dr. Evron specializes in endocrinology. He earned his medical degree at University of Pennsylvania. He completed an internship at University of Florida, as well as a residency in internal medicine and a fellowship in endocrinology at the University of Pittsburgh Medical Center. Dr. Evron is board-certified by the American Board of Internal Medicine. He practices with Evron Endocrinology Associates, a division of St. Clair Medical Services. To contact Dr. Evron, please call 412.942.7295 . 10 I HouseCall I Volume X Issue 1
Excellent
Good
Poor
HbA1C Test Score
4.0
5.0
6.0
7.0 8.0
9.0
Mean Blood mg/dl
50
80
115
150 180
215 250 280
350
380
Glucose mmol/L
2.6
4.7
6.3
8.2 10.0
11.9 13.7 15.6 17.4 19.3
21.1
10.0 11.0 12.0 13.0 315
endocrinologist and Dr. Popovich recommended St. Clair Hospital’s
14.0
KEEPING BLOOD SUGAR LEVELS IN CHECK A glucose chart acts as a reference guide for blood sugar test results and is an important tool for diabetes
management. Most diabetes treatment plans involve keeping blood sugar levels as close to normal or target goals as possible. Frequent at-home and doctor-ordered testing, along with an understanding of how results compare to target levels allow patients to assess and self-monitor blood sugar test results.
Recently Dr. Evron had Carla begin using a continuous glucose
Wayne A. Evron, M.D., FAACE. Carla saw him for the first time in March.
monitor (CGM) and that has provided an entirely different level of
He did an A1C in the office and the result was her all time high of 8.5.
information to her about how her blood sugar level responds to food
Carla hadn’t realized she had slipped that much.
and exercise. The sensor gives her accurate readings and information
Seeing Dr. Evron has made a big difference, and now she’s getting
about her blood sugar patterns. “It’s easy to use and it frees me from
a better handle on her diabetes. “When I do what I should, my blood
finger sticks,” she says. “Now I know exactly what my blood sugar is
sugar is stable,” she says. “I know how to choose food well, measure
after an hour of exercise or after a meal. I’ve been able to reduce my
portions, count carbs, pay attention to my weight and monitor my
medication since I began using it.”
blood sugar, but I went back to the Diabetes Educator at St. Clair for
With Dr. Evron, Carla believes she is making a fresh start.
a refresher course and that was helpful. Knowledge is power; I may
“Dr. Evron said to me at my first visit, ‘We’re going to work hard at this.
not know all the science but I know what works.”
Help me help you.’ His words made me feel confident and supported.
Carla has a son, Clay, 28 and a daughter, Julie, 24, and she works
For 11 years, I neglected my health, and I waited a long time before
part-time at the Upper St. Clair Library. In the early years of her
I truly cared about my diabetes. Fortunately, I’ve had no complications;
marriage, Carla and her husband Ken lived in San Francisco, and
my eyes and my feet are fine.” Carla feels
their home was within walking distance of many wonderful restaurants.
hopeful and motivated, and says that
It was hard to resist all that great food, and with her first pregnancy,
life is better now that she is back
she gained more than the recommended amount of weight. It was
on track, managing her diabetes
difficult to lose the pregnancy weight, as many mothers find, and she
better than ever. n
developed gestational diabetes with her second pregnancy. Carla wonders if she could have prevented both her gestational diabetes and her Type 2 diabetes, and she worries about the risk to her kids. But according to Dr. Evron, the development of diabetes is largely a matter of genetics, and given Carla’s family history, it was probably inevitable. “The risk of developing diabetes is higher for the child born of a gestational diabetic pregnancy, but mostly because of genetics,” he explains. “The risk to the child is anywhere from 10 percent to 50 percent.” Life with diabetes requires a lot of planning and constant learning, Carla says. “I read Diabetic Living magazine and I’m always learning. I’m especially successful when I walk every day. I walk my dogs and those walks definitely help control my
Carla says staying active helps her control her blood sugar.
blood sugar.”
Volume X Issue 1 I HouseCall I 11
UNDERSTANDING DIABETES Continued from page 11 7
A Patient’s Story
Jayne: Even with diabetes, it’s a wonderful life. Jayne Sterling is a woman in love with life. She lives life to the fullest, enjoying every moment as a wife, mother and grandmother, and seeing as much of the world as she possibly can. “There is no way
that she see an endocrinologist, and she made an appointment with St. Clair Hospital’s Bridget K. Beier, D.O. The diagnosis of Type 2 diabetes did not come as a complete
that diabetes is going to get me down,” declares Jayne, and the tone
surprise; Jayne’s mother and one of her brothers have diabetes.
of her voice makes you believe her. This lively, energetic world traveler
“Dr. Beier gave me the diagnosis. I liked her from the very first
has a zest for life that keeps her constantly active and engaged.
moment I met her. She’s personable, takes time with me and always
“I’m a young 71,” she says, “and I am always on the go. I was a
gets back to me when I call her. I take (prescription medication)
physical education major and I am not a sitter. I work out; I have
Metformin and I’ve had to change my eating habits, but I did not need
energy.” That characteristic made her sudden development of severe,
to lose weight. I was never overweight; I’m a size 2, but I have not
late afternoon fatigue quite out of the norm 12 years ago when she
been the healthiest eater. I never knew a vegetable! I was a sugar
was working at her job in the jewelry industry. Jayne was at work
addict all my life and I love candy. Luckily something in the
when she began experiencing the desire to lie down and nap around
Metformin killed my huge appetite for sweets.”
three every afternoon. She would eat candy to spark her energy, and it would give her a quick but short-lived boost. A co-worker suggested
Jayne’s approach to diabetes management is to rely on her doctors, follow their recommendations, and find ways to enjoy
A HEALTHY-EATING PLAN A healthy-eating plan is one that’s naturally rich in nutrients and low in fat and calories. Key elements are fruits, vegetables, fish and whole grains. In fact, a diabetes diet is the best eating plan for most everyone. Embracing a healthy-eating plan is the best way to keep blood glucose levels under control and prevent diabetes complications. Source: www.mayoclinic.org/diseases-conditions/diabetes/in-depth/diabetes-diet/art-20044295
12 I HouseCall I Volume X Issue 1
eating within the limits of diabetes. “You have to find food that you
diabetics is to accept it and take it one day at a time. “I believe that
really like. You will want the wrong things if you are eating food that
anyone can adapt to diabetes. You adapt to it because you have to —
you don’t enjoy. I avoid pasta and have it maybe once a week, and
that’s really all there is to it. My mother’s diabetes was not well
there is no bread in my house! I was never a big eater, so what works
controlled and I saw how that affected her. I’m not perfect; I have a
for me is a breakfast of scrambled egg and bacon and some fruit; for
cookie now and then. But most of the time I do very well and I have
lunch I have a packet of crackers and my main meal is dinner. I eat
managed my diabetes for 12 years now. I respect my doctors and
lots of fish. This is what works for me, and I enjoy what I eat.” Dr. Beier
I listen to them; I have two brothers who are doctors.
praises Jayne for her positive attitude. “Jayne has Type 2 diabetes
“I believe in enjoying and celebrating your life because it can be
which can be a discouraging diagnosis for many people. Jayne remains upbeat and realizes that leading a healthful lifestyle can have a huge
cut short. You can live with diabetes; you can even live a wonderful
life with diabetes. I do!” n
impact on achieving and maintaining excellent diabetes control. She travels frequently, but makes sure to exercise regularly and watch her diet even when away from home.” Jayne and her husband Tom have been married for 50 years. They love to spend time with their daughter Tess, son T. L., and three grandchildren. Jayne travels often and loves to go to Europe, especially
Bridget K. Beier, D.O.
to Krakow, Poland and to Italy. Jayne’s advice to newly diagnosed
“
A HEALTHFUL LIFESTYLE
CAN HAVE A HUGE IMPACT ON ACHIEVING AND MAINTAINING EXCELLENT DIABETES CONTROL.
”
BRIDGET K. BEIER, D.O., ENDOCRINOLOGIST, ST. CLAIR HOSPITAL
BRIDGET K. BEIER, D.O. Dr. Beier specializes in endocrinology. She earned her medical degree at Lake Erie College of Osteopathic Medicine and completed her internship and residency at the University of Connecticut Health Center and a fellowship at Virginia Commonwealth University Health System. Dr. Beier is board-certified by the American Board of Internal Medicine. She practices with Associates in Endocrinology, P.C. To contact Dr. Beier, please call 412.942.2140. Volume X Issue 1 I HouseCall I 13
UNDERSTANDING DIABETES Continued from page 13
A Patient’s Story
Scott: Freedom fighter. Scott Kleinhans is a warrior with an intrepid spirit and June 1, 2015 was a personal D-Day for him. On that day, the 64-year-old Upper St. Clair resident had a heart attack, underwent heart surgery, and was told that he had diabetes. It would be an understatement to say that a single day changed his life; it essentially sliced it into Before and After. Scott had to learn a new way of life, within the dual constraints of heart disease and diabetes. He has done that, and done it exceptionally well by making the most of his motivations, educating himself, and fighting for his health. It is a battle that he is winning. He contends that the most significant lesson he has learned on this unexpected journey is that self-care is paramount. “Long before my own diagnosis, I saw firsthand what the lack of self-care can do to a person with diabetes,” he explains.
14 I HouseCall I Volume X Issue 1
“I had a relative with diabetes who did not manage it well. Her
sticks. I’m making enough insulin for the way I eat.” He attributes his success in part to the supportive partnership
attitude was, ‘I’ll eat what I want and just take more insulin.’
he has with Linda. Their mutual interests in improving their health
Her blood sugars were unstable, and would go from 60 to 600.
converged in a radical change in their eating habits. “We’ve based
I helped care for her and she had many complications.”
our diet on a book about reversing heart disease. Eating healthy
Motivated by this experience, and wanting to stay healthy to enjoy life with his beloved family — wife Linda; two sons, William,
has changed our lives. No dairy, no gluten, no processed food or
28, and Stephen, 24; and dog Butterscotch — Scott was resolute
preservatives. Lots of fresh vegetables! I do much of the cooking
in his effort to get a handle on diabetes. Endocrinologist Camille M.
and we eat well, plus we eat as much as we want. I miss pizza,
Buonocore, M.D., saw him while he was
but we’re amazed at how happy we are and how good we feel. Our
at St. Clair, recovering from heart surgery;
“
she started him on insulin immediately. “It was very hard, mentally, at first,” he says. “After I was discharged I went to the classes; I had two one-on-one sessions and then a group. It was helpful. I had to learn how to eat with diabetes. I was on insulin four times a day, and I had to check my blood sugar with finger sticks three times a day. I did research
allergies have improved. My cardiologist says my heart sounds great.” Scott’s work as a custodian is physically active, and he and Linda also exercise
I’m proof that it is possible to get freedom from diabetes.
and went to my doctors, including my primary care physicians Richard J. Egan, Jr., M.D., and Joshua B. Goldman, D.O., with my questions. I knew it was going to be hard, but I had to try.”
”
Scott says that at times, he has felt impris-
where they like to walk in the resistance stream in the pool. Dr. Buonocore says that Scott is fortunate to have been able to come off insulin, although this will not be possible for every diabetic. “Scott has done very well and his case demonstrates the benefits of restricting high calorie foods, watching
SCOTT KLEINHANS, PATIENT
oned by his condition. It’s a common feeling among those with
regularly at the Upper St. Clair Recreation Center,
portion size and exercising. It also emphasizes the importance of family support to a diabetic. Although I don’t support following gluten-free
or dairy-free diets when they are not medically necessary, they do
diabetes. He wanted, above all, to be free of insulin shots and he
impose dietary restrictions, which help some patients control
resolved to do whatever it took to achieve that freedom, including
their caloric intake. Improving diet and adding daily exercise will
losing weight. “I’m not fat, but I’m a big guy,” he explains. “I wanted
help diabetic control, blood pressure and cholesterol.”
to lose weight to get better control, and after my heart attack my
Scott acknowledges that it takes enormous discipline to
weight was inching up. As I lost weight, my blood sugar kept falling
maintain his regimen. “I’m motivated because I don’t want to
and I worked with Dr. Buonocore’s nurse practitioners, Deborah
be trapped by diabetes. When you’re diabetic, you have to think
Meriney and Antoinette Thalman, to reduce my insulin to correspond
about diabetes constantly and your life revolves around it. But
to eating less. My wife, who is pre-diabetic, and I went on a diet and,
it doesn’t have to be miserable. If you learn about diabetes and
after three months, my blood sugars were in the low 90s.
nutrition, you can get some control over it and still enjoy life.
I felt great and I was able to cut back on insulin. Later, my blood
My blood sugar is rock steady and I am free of insulin shots.
sugar stabilized further and I stopped insulin altogether. I take
I’m proof that it is possible to get freedom from diabetes.” n
(prescription medication) Metformin every day now and I do finger
Volume X Issue 1 I HouseCall I 15
UNDERSTANDING DIABETES Continued from page 15
A Patient’s Story
Jamie: Controlling diabetes, the key to a healthy pregnancy. With three active children under age 10, plus a new baby born at St. Clair Hospital’s Family Birth Center, Jamie Andreola, 39, has her hands full. But she and her husband Tony, children’s pastor at South Hills Assembly Church, keep their Bethel Park household running smoothly and happily, and Jamie’s skills have translated well to her self-management of gestational diabetes. Jamie is a pro, having had the condition with her third and fourth pregnancies; she is masterful in choosing healthy foods that nurtured her and the growing fetuses, kept her blood sugar stable and her weight in a healthy range. It isn’t simple, but Jamie has it down, and she has some advice for expectant mothers with gestational diabetes. “My diagnosis was not entirely a surprise, because my sister had gestational diabetes. Still, it felt like boot camp at first. I needed to learn the basics of nutrition and adjust my habits. Fortunately, I had great help from the dietitian at St. Clair’s Diabetes Center. My OB/GYN doctor, Deborah A. Lenart, M.D., referred me to her and she was excellent; she gave me menu ideas and recipes.” One of the most important principles that Jamie learned was that she needs to eat protein at every meal. “Protein helps to stabilize my blood sugar; it levels out my mood and keeps me from having cravings. Most snack foods are carbohydrates and they are the easiest thing to grab when you are hungry. I know now to snack on protein. My favorite snacks are peanut butter on apple slices; unsalted peanuts; Colby Jack cheese sticks and turkey pepperoni. I know to always have them cut up and ready.” Readiness is a key for anyone who is managing diabetes, Jamie says. “I can’t leave anything to chance. Everywhere I go, I have protein bars and peanut butter crackers with me. The key to healthy eating with diabetes is to shop well and often so that you always have the right foods on hand. Failing to plan is what will get you into trouble.”
“
Jamie Andreola and her beautiful and healthy baby boy, Joshua.
Dr. Beier and Dr. Buonocore are amazing. They give me encouragement and confidence. JAMIE ANDREOLA, PATIENT
16 I HouseCall I Volume X Issue 1
”
Dr. Lenart also encourages women
Although some women with gestational diabetes need insulin,
who are hoping to have a baby to begin
Jamie kept her blood sugar stable with diet alone. “I eat a good breakfast of eggs and sausage plus one piece of high grain bread; I can have toast because of all the protein. As long as I watch my carbs and have protein at every meal, I’m
pre-conception planning for a healthy
Tony and Jamie Andreola with their growing family.
pregnancy. “Get in shape first, before you conceive. If you need to lose weight or eat healthier, get into a
okay. I’ve learned to avoid pasta, rice and chips; I eat more veggies and if I crave sweets, I have a few
routine of healthful eating and
grapes. For exercise, I swim. Exercise brings my
exercise well ahead of becoming
blood sugar down, helps me manage my weight, and
pregnant. Pregnancy is an opportunity to create a foundation for
makes me feel better.”
the long term health of the child,
Gestational diabetes is the most common compli-
but also for the mother,” she says.
cation of pregnancy, affecting four percent of pregnancies
St. Clair offers a lifestyle management
in the U.S. According to Dr. Lenart, Chair of the Depart-
program called Fit for Two, designed to
ment of Obstetrics and Gynecology at St. Clair, screening for gestational diabetes is a routine part of good prenatal care.
help obese women better manage their
“Gestational diabetes simply means glucose intolerance during
weight through good self-care and nutrition. A woman who has had diabetes and becomes
pregnancy. It is usually asymptomatic. All pregnant women should have a glucose tolerance test at 24 weeks, or earlier if there are risk factors.
pregnant has a completely different situation from a gestational diabetic,
We give them a glucose challenge with a sugary drink and check the blood
Dr. Lenart explains. “The diabetic patient may need to be managed
sugar an hour later; if the one-hour test is abnormal, then we proceed to
with a high risk perinatologist plus an endocrinologist. She will require
a three-hour glucose tolerance test, and that clinches the diagnosis. The
absolutely tight control before and during pregnancy.”
first step is to see a dietitian, to learn what and how to eat and try to stay
Dr. Lenart referred Jamie to endocrinologists Bridget K. Beier, D.O.,
diet-controlled. We want the glucose to be tightly controlled, so there
and Camille M. Buonocore, M.D., of Associates in Endocrinology, P.C.
may be a need for medication. We will do more frequent stress testing
once the diagnosis of gestational diabetes was made. They taught her
and ultrasounds, we encourage exercise and we monitor weight gain
how to self-monitor her blood sugar levels. “Dr. Beier and Dr. Buonocore
carefully. Gestational diabetics are at increased risk to need a C-section.”
are amazing,” Jamie says. “They give me encouragement and confidence.
Most women who develop gestational diabetes, says Dr. Lenart, will have
I prick my finger four times a day: first thing in the morning, then again
a healthy pregnancy and a healthy baby. In some cases, a medically
after each main meal, and I report my numbers to them.”
indicated early induction may be needed. Risk factors for gestational diabetes include a previous pregnancy
Jamie Andreola and her healthy children are living proof that with
with the condition; a previous infant with a birthweight of nine or 10
good prenatal care and support
pounds; maternal obesity and high BMI; and family history of diabetes.
from diabetes experts, a woman
Older mothers have a higher risk. For both mother and baby, there is
with gestational diabetes can
an increased risk of developing Type 2 diabetes later in life, so follow-up is essential. Dr. Lenart recommends having a glucose tolerance test
have a healthy pregnancy and
a healthy baby. n
within 4-6 weeks post-partum.
Camille M. Buonocore, M.D.
CAMILLE M. BUONOCORE, M.D. Dr. Buonocore specializes in endocrinology. She earned her medical degree at State University of New York at Buffalo and completed her internship and residency in internal medicine, as well as a fellowship in endocrinology, at the University of Pittsburgh Medical Center. Dr. Buonocore is board-certified by the American Board of Internal Medicine. She practices with Associates in Endocrinology, P.C. To contact Dr. Buonocore, please call 412.942.2140. Volume X Issue 1 I HouseCall I 17
UNDERSTANDING DIABETES Continued from page 17
“
Diabetes is not devastating, you can live a full life.
”
JIM DEVATY, PATIENT
Jim Devaty, at home with son, Aiden. 18 I HouseCall I Volume X Issue 1
A Patient’s Story
Jim: The balancing act of managing diabetes. Jim Devaty makes a killer strawberry rhubarb pie, he says. He is an
sentence. I knew I could manage it.” The toughest part of living with
entrepreneur and software engineer, now a stay-at-home Dad. For him,
diabetes, he says, is the regimentation. “Regimented eating is tough.
good food is a passion, and he shines in the kitchen. “I love food and I love
A few years in, I slacked a bit. But I got back on track and now I under-
to cook. I enjoy going to new restaurants and I love to try new recipes,
stand that it comes down to balance and portion control. I strive to keep
especially desserts.” The fact that he has Type 1 diabetes makes this a
my blood sugar levels really tight, because it’s actually easier when you
challenge, but Jim has applied his considerable resourcefulness and
keep it tightly controlled. My goal is to keep my A1C (blood sugar level)
creativity to the limits imposed by the condition: “I eat what I love, but
below 7 and so far I have had no complications.”
not like I once did. Pasta is not typically an entrée but a side dish; dessert is occasional, not daily. Dining out is tough because I don’t know what’s
Six years into diabetes, Jim chose to switch to an insulin pump with an integrated continuous glucose monitoring system (CGM), even though
in the food. If my blood sugar is up, it’s usually after eating out. So, we
he says it requires discipline. “With a pump you have greater flexibility
mostly eat at home, but we eat very well.”
and less regimentation, but you have to think about things more. It’s easy
Jim’s family includes husband Stephen Miller, a high school math
to be ‘bad’ and then give yourself a bolus (a dose of insulin). I’ve been on
teacher, and their son Aiden, 10. A native of the South Hills, Jim went
a pump now for 10 years. My continuous glucose monitor is amazing
to Upper St. Clair High School and then to Virginia Tech; he founded a
and I love it; the sensors are incredibly accurate.”
software engineering company with friends and lived in the D.C. area
Jim credits the strong support he has had from health care profes-
and southwestern Virginia for years. The couple returned to Pittsburgh to
sionals, especially Dr. Beier, for his success.“ Dr. Beier is great. She’s an
raise their son, and they now reside in Whitehall. Jim was always healthy,
osteopath and they have a slightly different approach. My sister referred
but the diagnosis of diabetes at 38 was not a complete surprise, because
me to her practice when we moved to Pittsburgh and I love the rapport
he has a sister who has had Type 1 diabetes for years. “I developed symptoms
I have with her. She’s incredibly caring and a top notch physician. I feel
of thirst and lethargy, and because I was familiar with diabetes, I quickly
that we have a partnership in my care.”
recognized what was happening,” he recalls. “Though I had a routine physical already scheduled with my primary care physician, I called the
Dr. Beier views Jim as a role model. “Jim is very inspirational. He has Type 1 diabetes, which is a challenging disease to live with, but
office and described my symptoms. They saw me the next morning.
he has found a way to have balance in his life. He is careful and
My glucose was 435. I was still producing insulin and it wasn’t that difficult
conscientious and has made lifestyle modifications to keep his blood
to manage. I started injecting insulin and saw a dietitian, and that helped
sugars under good control. Yet he still enjoys food and has found a
a lot; we got it under control pretty quickly. At first, I was incredibly strict
way to integrate healthy living into his daily life.”
with myself, even a bit Draconian. I wasn’t fat, but I needed to lose a few
With 16 years of experience as a Type 1 diabetic, Jim has hard-earned
pounds and I went overboard. I learned to moderate my diet and things
wisdom to share with newly diagnosed diabetics. “Don’t be concerned
finally stabilized. From this experience, I learned the importance of
that you can’t deal with this. You can. You’re going to be fine. You have to
balance. All diabetics have to find a balance: that is what allows you
pay attention to how you’re taking care of yourself and listen to your doctor.
to manage your diabetes.”
The key is to be good most of the time; you can’t splurge every day.
People with diabetes do have some control, says St. Clair Hospital
People want to control diabetes and you cannot; diabetes controls you.
endocrinologist Bridget K. Beier, D.O., who treats Jim. “It’s important
But diabetes is not devastating, you can live a full life.” As proof of that,
to understand diabetes as soon as possible after diagnosis,” she says.
Jim and his family recently spent 10 days vacationing in Hawaii. “You can
“That’s a critical time for diabetes education. It isn’t simple, but if you
splurge when you're on vacation. We dined out for every meal and I indulged
focus on a few things, you can manage it: learn to make meal plans;
in the delicious fruit of the islands, tropical drinks and some desserts.
do your cooking on the weekend; find an exercise that you enjoy and
My glucose levels were elevated and I used more insulin than I typically
make it part of your routine.”
do, but I kept my glucose levels in check. Now that I'm home I'm back
Jim says his attitude toward his diabetes is one of acceptance. “The first year after you are diagnosed, you have to settle in to the diagnosis and new lifestyle. I’d rather not have diabetes, but it was not a death
to my normal routine.” And that routine includes the occasional new restaurant and a piece
of homemade strawberry rhubarb pie. n
Volume X Issue 1 I HouseCall I 19
UNDERSTANDING DIABETES Continued from page 19
Living with
DIABETES
Preventing complications with patient education
Pennsylvania has the dubious distinction of having one of the highest diabetes rates in the nation. According to the Centers for Disease Control and Prevention (CDC) and the American Diabetes Association (ADA), Pennsylvania has 1,456,000 residents who are diagnosed with diabetes, which is nearly 13 percent of the adult population. Every year in the state, 71,000 people are diagnosed with the disease. In addition, 36 percent of adults in Pennsylvania have pre-diabetes and most are unaware of this.
I
n response to these trends, St. Clair Hospital has established a
Despite the strong evidence of its benefits, diabetes education is
comprehensive Diabetes Center to educate and counsel persons
underutilized, Cindy says. “The ADA reports that 56 percent of all persons
with diabetes and pre-diabetes. At the Diabetes Center, an expert
with diabetes have never had diabetes education; there are many more who
team of specially certified diabetes educators and registered dietitians,
had it decades ago, and have never gone back to update their knowledge.
in coordination with physicians, are thoroughly prepared to help anyone
People may underestimate the value of it, and some physicians do, too.
who is in need of diabetes education: the newly diagnosed, those who
Not all physicians make referrals or tell their patients with diabetes that
have a change in their condition, and those who have had diabetes
“
for a long time but are in need of a refresher course. Family members are encouraged to participate.
WE WANT TO HELP YOU
Diabetes education at St. Clair is personal and comprehensive. It consists of individual appointments and several classes that cover the basics of diabetes self-care and management:
LIVE A GOOD, LONG AND HEALTHY LIFE.
basic physiology, nutrition, blood glucose testing, insulin administration, medication management, exercise, weight management and the prevention of complications. St. Clair Hospital’s Cindy Donovan, M.A., R.D.N., Certified Diabetes Educator, has been a diabetes educator for 25+ years. She says that ideally, a person newly diagnosed with diabetes should be given an immediate and automatic referral for classes. “Diabetes education should be regarded as essential. Patients should be seen individually, followed by group classes at the beginning, and then an annual refresher to reinforce what they have learned and to bring them new information. In addition, the ADA recommends that education be provided when there is a change in treatment or the development of a complication. Studies have shown that those who come for education are more likely to take their medication as prescribed and to follow their doctor’s recommendations; they are more motivated. Diabetes education prevents costly and often catastrophic complications.”
20 I HouseCall I Volume X Issue 1
”
CINDY DONOVAN, M.A., R.D.N., CERTIFIED DIABETES EDUCATOR, ST. CLAIR HOSPITAL
the Diabetes Center is available to them. In addition, not all health
to accept the diagnosis and may not be receptive to education. If they
insurance policies cover it completely, although Medicare has an annual
are very distressed, we may make a referral for counseling and we will
benefit for diabetes which includes both medical nutrition therapy and
let the referring physician know.”
diabetes self-management education.” Cindy believes that those with diabetes should take advantage of the
Antonio M. Riccelli, M.D., a primary care physician with St. Clair Medical Services, values diabetes education and refers all of his patients with
training as soon as possible after diagnosis. “We meet with clients one on
diabetes to the Diabetes Center at St. Clair as soon as they are diagnosed.
one for diabetes education and the appointments are approximately one
“Diabetes education should be the very first thing the patient does after
hour long. A lot of information all at once is overwhelming, so we break it
getting the diagnosis. Diabetes is hard to understand and many people are
up. We try to meet them wherever they are in their acceptance of the
overwhelmed by it. It’s a difficult disease to manage; to be successful, you
diagnosis; we assess what stage they are in, along with their willingness
have to understand the disease, the importance of taking your medications
to make lifestyle changes. We help them set goals and assist them to meet
and keeping follow up appointments. It’s critically important that the patients
the goals.” St. Clair Endocrinologist Monica A. Gomberg, M.D., concurs:
be educated in all aspects of diabetes and St. Clair does this very well.
“It’s important to get educated about diabetes as soon as possible. You need a lot of support, and you can get that from the Diabetes Center. The diabetes educators do an excellent job. I find that I have better luck at getting patients to attend classes when they are first diagnosed. If patients don’t go at diagnosis when motivation is typically at its peak, they may not make time to attend classes later on and can miss out on this valuable opportunity for learning. Having a more thorough understanding of diabetes can only help patients later on, and hopefully they can take away tools to help them manage their diabetes later on.” Cindy acknowledges that for some people, a little more time is needed. “When a person is diagnosed, they may need time to adjust and let the surge of emotions subside before they are ready for classes. Shock, anger and denial are common reactions; some are not ready
Continued on page 22
STEPS FOR
BETTER LIVING WITH DIABETES 1 Eat healthfully 2 Be active 3 Monitor A1C 4 Take medication 5 Reduce risks
RESOURCES AT ST. CLAIR HOSPITAL FOR PEOPLE WITH DIABETES Individual Nutrition Counseling
Group Diabetes Education
Individual meetings with a registered dietitian for nutrition counseling to develop a personalized meal plan and learn about carb counting, portion control, weight management and other concerns.
An interactive learning experience that covers all the basics, including strategies for managing the daily challenges of diabetes.
Diabetes Wellness Group Individual Diabetes Self-Management Individual meetings with a certified diabetes educator to assess your learning needs or help you acquire a new skill, such as how to test your blood glucose or administer insulin.
Gestational Diabetes Education Individual appointments for women who develop diabetes during pregnancy, with a certified diabetes educator, to teach you healthful eating and managing your blood sugar.
A free class that is open to the public and does not require a physician referral. Various experts present topics related to diabetes care and management.
Additional Information Individual and group diabetes education sessions and nutrition counseling require a physician referral. Please ask your primary care physician or endocrinologist for a referral, or call the Diabetes Center for assistance.
The Diabetes Center at St. Clair Hospital is located at the Outpatient Center–Village Square in Bethel Park. Call 412.942.2151 to schedule an appointment for diabetes education or to ask about upcoming events. There are day and evening options. Please note: Registration is required for all classes.
Volume X Issue 1 I HouseCall I 21
UNDERSTANDING DIABETES Continued from page 21
Living with
DIABETES
Dr. Riccelli notes a difference in his patients
Cindy envisions continued growth for the
who participate in diabetes education. “The
Diabetes Center as it meets the challenges
patients who go to the Diabetes Center tend to
of the growing population
have better A1C (sugar) levels and to be more
affected by diabetes.
compliant in seeing the ophthalmologist and
“At St. Clair, we are
other specialists. About half of my patients go
looking at new, more
Many patients think diabetes means no more
willingly; others need to be coaxed. Diabetes
consumer-friendly
sugar; they need the classes to learn the basics
demands a total team effort from patients and
models, including online resources and providing
Continued from page 21
of nutrition: what is a carbohydrate and how
all the medical experts involved, including the
does it become sugar in your body; what does
dietitian and diabetes educator, who are critical
classes in physicians’
a diabetic diet mean?”
to the process.”
offices. Doctors have
Continued on page 23
Diabetes Glossary A1C > A blood test that measures average blood sugar over the past
Diabetes education > The basics of diabetes self-care and
two-three months. It is different from the blood sugar checks that
management, including nutrition, blood glucose testing, medication
people with diabetes do every day. Most often it should be below
management, exercise and the prevention of complications; usually
5.7, but it may be different for some individuals.
taught by a specially certified dietitian or registered nurse.
Carbohydrate > A major class of food that includes starches,
Fasting blood sugar > A measure of blood glucose level taken
pasta, bread, potatoes, and sweets. Carbohydrates have the greatest
before one eats; measured in milligrams per deciliter (mg/dl).
effect on blood sugar, compared to protein and fat.
Gestational diabetes > A temporary form of diabetes that
Carb counting > A meal planning tool in which you keep track of
develops during pregnancy and may cause complications for the
the amount of carbohydrate grams in the food you eat. Carb counting
mother and baby.
can help people with diabetes manage their blood sugar levels.
Glycemic index > A measure of the rate at which ingested food
Continuous glucose monitor (CGM) > An FDA-approved device that provides and displays continuous information about your blood
causes the blood sugar to rise. Also refers to a ranking of foods according to the glycemic index.
sugar levels, 24/7. It tells you if your blood sugar is rising or falling,
Hyperglycemia > An excess of sugar in the blood, causing high
and how fast it is changing, so that you can better manage your
blood glucose levels.
blood sugar.
Diabetes > A chronic disease in which the body is unable to properly use and store glucose (sugar) so that it collects in the bloodstream and rises above a healthy, normal level.
Hypoglycemia > An abnormally low level of sugar in the blood. Insulin > A hormone secreted normally by the beta cells of the pancreas that is essential for regulating glucose levels in the blood. Insulin moves sugar from the blood into the cells to be converted
Diabetes Type 1 > A condition in which your pancreas stops
to energy. Without it, the blood sugar rises and diabetes results.
producing insulin, the hormone that your body needs every day
Insulin resistance > Reduced sensitivity to insulin that is
to take sugar from the food you eat and convert it to energy.
common in Type 2 diabetes.
Diabetes Type 2 > A condition in which the body does not
Pre-diabetes > An asymptomatic, abnormal state that precedes
make enough insulin or is unable to use insulin correctly. This is
the development of clinically evident diabetes. It means your blood
also known as insulin resistance. Type 2 is the most common
sugar is higher than normal but not high enough for a diagnosis
type of diabetes.
of diabetes.
22 I HouseCall I Volume X Issue 1
THE CDC PRE-DIABETES SCREENING TEST
tight schedules and little time to teach, but
COULD YOU HAVE PRE-DIABETES?
primary care physicians are most often the initial
Pre-diabetes means your blood glucose (sugar) is higher than normal, but not yet diabetes.
diagnosticians and they do most of the medical
Type 2 diabetes can be delayed or prevented in people with pre-diabetes through
effective lifestyle programs. Find out your risk for prediabetes.
TAKE THE FIRST STEP — KNOW YOUR SCORE!
For each “Yes” answer, add the number of points listed. All “No” answers are 0 points. YES NO
management of diabetes. Education needs to become more geared to younger people, too, as the incidence of diabetes is skyrocketing among that group.” With her extensive experience, Cindy has witnessed a sea change in diabetes care. “In the
1
0
Are you a woman who has had a baby weighing more than 9 lbs. at birth?
1
0
Do you have a sister or brother with diabetes?
1
0
Do you have a parent with diabetes?
to finger sticks as home glucose meters became
5
0
Do you weigh as much or more than listed for your height on the chart?
available in the 80s. Now we are moving past that
5
0
Are you younger than 65 and get little or no exercise in a typical day?
5
0
Are you between 45 and 64 years of age?
9
0
Are you 65 years of age or older?
AT RISK WEIGHT CHART WEIGHT (lbs)
HEIGHT
WEIGHT (lbs)
4’10”
129
5’8”
177
4’11”
133
5’9”
182
5’0”
138
5’10”
188
5’1”
143
5’11”
193
5’2”
147
6’0”
199
5’3”
152
6’1”
204
5’4”
157
6’2”
210
5’5”
162
6’3”
216
5’6”
167
6’4”
221
5’7”
172
were acting on old information. Then we progressed
with amazing advanced technology and new insulin and medication products. I‘ve learned so much from patients and I understand that many people feel trapped by diabetes, but some are more positive
IF YOUR SCORE IS 3 - 8 POINTS
HEIGHT
old days, we tested urine for glucose levels, but we
This means your risk is probably low for having pre-diabetes now. Keep your risk low. If you’re overweight, lose weight. Be active most days, and don’t use tobacco. Eat low-fat meals with fruits, vegetables, and whole-grain foods. If you have high cholesterol or high blood pressure, talk to your health care provider about your risk for Type 2 diabetes.
IF YOUR SCORE IS 9 OR MORE
This means your risk is high for having pre-diabetes now. Please make an appointment with your health care provider soon.
and eventually see it as an opportunity because it can lead them toward a healthier lifestyle. “We want to make sure that people throughout the community know that we are here and our diabetes education programs have great value. Diabetes education is one of the most significant factors in how well you manage your disease and avoid complications. Your primary care physician can refer you to the St. Clair Diabetes Center, but you might have to ask for it. We’re here, close to home, and we want to help you live a good, long and healthy life.” n
Source: www.cdc.gov/diabetes
“
IT’S IMPORTANT TO GET EDUCATED. . .
YOU NEED A LOT OF SUPPORT, AND YOU CAN GET THAT FROM THE DIABETES CENTER. MONICA A. GOMBERG, M.D., ENDOCRINOLOGIST, ST. CLAIR HOSPITAL
”
MONICA A. GOMBERG, M.D. Dr. Gomberg specializes in endocrinology. She earned her medical degree at Chicago Medical School and completed her internship at UPMC Medical Education-Internal Medicine Program and a fellowship at UPMC Medical Education Program in Endocrinology. She is board-certified by the American Board of Internal Medicine. She practices with Associates in Endocrinology, P.C. To contact Dr. Gomberg, please call 412.942.2140.
Volume X Issue 1 I HouseCall I 23
ASK THE DOCTOR
Ask the Doctor EDWARD J. RUANE, JR., M.D.
Q A
What’s the difference between types of dermal fillers? Is there one that would last longer or work better for me?
As we age, our faces naturally lose the fat just below the
None of these hyaluronic acid-based fillers are
skin; smile lines, worry lines and creases appear and the
permanent though, and how long they last relates to
skin stretches a bit, adding to a loss of facial volume.
the thickness of the filler used. Most last in the range
Dermal fillers play an important role in helping to
of 6 months to 12 months, but some are reported to
diminish these and other signs of aging. In addition to
offer results up to 18 months.
Botox, injectable dermal fillers can help to reduce fine
If you’re looking for a more permanent filler, the
lines and wrinkles and restore volume and fullness to the
perfect choice might be fat injections, using your own
face. They can add volume to thin lips or hollow cheeks;
fat. After determining a "donor area," such as your
they can enhance shallow contours, soften creases, and
thighs or abdomen, fat is extracted by liposuction.
improve the appearance of scars. Dermal fillers produce
The suctioned fat is then transferred to the face as a
natural results and have minimal risks and side effects.
graft. About 50 percent to 60 percent of what’s
The majority of fillers are made up of hyaluronic acid,
injected will survive, but the surviving fat will last
a natural substance found in your own body. Hyaluronic
forever. Dermal filler injections can be performed in
acid is found in high concentrations in your skin and connective soft tissues.
the office; however, fat grafting requires a minor surgical procedure.
Dermal fillers vary mostly in terms of their
Despite all of the options above, if you begin to
viscosity, or thickness. The main consideration
have lower facial jowling or sagging neck skin, then
when choosing the filler that’s right for you is
it might be time to stop fillers and Botox and consider
your own goal for treatment. If you desire fuller
a surgical facial rejuvenation procedure. When
lips, then a thinner filler that will still keep your
considering facial rejuvenation, it is essential to have
lips soft and supple would be recommended. If,
a partnership with a plastic surgeon who understands
however, your goal is restoring volume to your
facial anatomy and the science of facial aging, and is an
cheeks, then a thicker, firmer filler should be used.
expert in facial surgery. This surgeon can best determine
And if the goal is treating smile lines on your face, then the right product might be something in
whether a noninvasive or invasive procedure will be
required to achieve your desired results. n
between. Your surgeon will determine the best option for you. Edward J. Ruane, Jr., M.D.
EDWARD J. RUANE, JR., M.D. Dr. Ruane specializes in all aspects of plastic surgery, ranging from reconstructive to cosmetic. He earned his medical degree at Duke University School of Medicine and completed a residency in Plastic Surgery at the University of Pittsburgh Medical Center, where he served as Administrative Chief Resident in the Department of Plastic Surgery. Along with Dr. Robert W. Bragdon, Dr. Ruane practices with St. Clair Plastic Surgery Associates, a division of St. Clair Medical Services. To contact Dr. Ruane, please call 412.572.6164.
24 I HouseCall I Volume X Issue 1
Frank A. Civitarese, D.O.
GOOD FOR US. BETTER FOR YOU. St. Clair Hospital has once again been recognized as one of the nation’s 100 Top Hospitals®. This marks the third time St. Clair has achieved this prestigious honor since 2012. It affirms St. Clair’s commitment to exceptional patient safety, clinical outcomes, patient satisfaction, and value. St. Clair is proud of the excellent care we provide our patients. We salute our outstanding physicians, employees, and volunteers for this notable achievement. To learn more about our award-winning care, please visit stclair.org.
100 Top Hospitals© is a registered trademark of IBM Watson Health™
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Volume X Issue 1 I HouseCall I 25
SUMMER SWING
ST. C L A I R H O S P I TA L 2 1 ST A N N UA L
More than 600 guests were transported to “A Night In
Old Havana” at St. Clair Hospital’s 21st Annual Summer Swing, conducted Friday, July 20 at St. Clair Country Club. Guests of
Summer Swing enjoyed the sights, sounds and tastes inspired by
Havana’s vibrant culture, including a Latin band, salsa dancers, conga drums, vintage cars, hand-rolled cigar demonstrations, plates of tamales, empanadas, jerk shrimp, Cuban Ropa Vieja
Sliders, and much, much more. Two days later, Summer Swing’s always popular golf outing attracted 124 golfers to the club’s championship course.
A special thank you to guests and sponsors who helped us raise
more than $320,000 for the Hospital’s growth and expansion,
including the construction of a six-story, comprehensive outpatient
center adjacent to the Hospital. n
THANK YOU TO OUR EVENT COMMITTEE Beth Evron, Co-Chair & Wayne Evron, M.D.
Tricia Hammel, Co-Chair & Bob Hammel
Katherine Biggs & Jason Biggs, M.D.
Laina & Brian Hammel
Bunny Bragdon & Bob Bragdon, M.D. Susan Bradley Brown & Steven Williams Katie & Dan Caste Nicolette E. Chiesa, M.D., FACP Wendy & Steve Denenberg Beth Erlanger & Daniel Erlanger, D.O. Nina Fatigati, M.D. & Christopher Pray, M.D. Tara Grahovac, M.D. & Erik Grahovac Wayne Evron, M.D. and Beth Evron with Tricia and Bob Hammel, Event Co-Chairs
26 I HouseCall I Volume X Issue 1
Veronica & Louis A. Guarino, Jr. Emily & Michael Hammel
Tara & Rob Hammel Vicki & Mark McKenna Julie Perricelli & Brett Perricelli, M.D. Carla Capozzi Riccelli, D.M.D. & Antonio Riccelli, M.D. Megan Shilling Suzy & Rich Sieber Marilynn Shogry & Robert N. Shogry, M.D. Gail & Andy Vater JoEllen Yeasted & G. Alan Yeasted, M.D. Michelle & Ron Yost Anne & Sam Zacharias
Angela & Ben Karcz, Gallagher Home Health, Presenting Sponsor
Jack, Renee & Lucas Piatt, Millcraft, Bronze Sponsor
Joseph Aracri, D.O. and Katherine Aracri
Vincent Reyes, M.D. and Kathleen Reyes
John Gibbons, M.D., & Simona Pautler, M.D., Partner Sponsor
St. Clair Hospital Breast Care Center Staff and Guests: Heidi Buzzelli, Tara Grahovac, M.D., Trevor Scott, Kelly Barry, Raye Budway, M.D., Chelsea Rodino
Veronica & Louis A. Guarino, Jr., Louis Anthony Jewelers, Bronze Sponsor
Dan and Katie Caste, Event Committee Members
Volume X Issue 1 I HouseCall I 27
1000 Bower Hill Road Pittsburgh, PA 15243 stclair.org
General & Patient Information: 412.942.4000 | Physician Referral Service: 412.942.6560 | Medical Imaging Scheduling: 412.942.8150 Outpatient Center–Village Square: 412.942.7100 | Urgent Care–Village Square: 412.942.8800 | Outpatient Center–Peters Township: 412.942.8400
THE IN HOSPITAL PATIENT
SAFETY
The Leapfrog Group, a national, independent, patient-safety watchdog, awarded St. Clair special recognition for the twelfth consecutive period, making St. Clair the region’s only hospital to consistently earn an ‘A’ grade for patient safety for six years running. The grades rate how well hospitals protect patients from preventable medical errors, injuries and infections. To learn more about our Hospital Safety Score, or St. Clair Hospital’s performance as a national leader in quality and patient satisfaction, please visit stclair.org. 1000 BOWER HILL ROAD
HouseCall
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is a publication of St. Clair Hospital. Articles are for informational purposes and are not intended to serve as medical advice. Please consult your personal physician.
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