March 17th, 2013

3/17/2013

 
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Type 2 diabetes is a genetic and lifestyle-related condition often attributed to years of unhealthy diet, coupled with lack of regular exercise. Although onset is gradual, once the condition develops it cannot simply be eliminated through changing habits that led to its development. Successful treatment requires a multi-level effort on the part of the patient, under supervision of a qualified endocrinologist.

The initial goal of diabetes treatment is to lower blood glucose levels to safe levels through undertaking sufficient regular exercise and altering diet around low-carbohydrate principles. It often takes patients several months to fully learn diabetes management skills as they involve a complex combination of food portion management; medication self-administration; recognizing and treating high glucose levels; handling and storing diabetes medical supplies; and coping techniques for sick days.

A critical aspect of successful diabetes management is self-monitoring of blood glucose (SMBG). This involves utilizing a glucose meter to take an accurate blood sugar reading. Although there are several types of glucose meters, they generally involve pricking the finger with a lancet, or small needle. The tiny resultant blood drop is placed on a test strip, which the glucose meter reads and processes digitally. Results of SMBG tests are usually available in a few seconds. The frequency with which blood testing must be undertaken depends on whether the patient has diabetes under control. Individuals just starting out on a SMBG regimen should utilize the glucose meter once or twice a day, while those with blood glucose levels that are under control can check a few times a week.

In addition to eating healthy foods, eating at roughly the same time each day is an important part of diabetes control. Consistency with foods eaten and portion sizes helps lessen blood glucose level ranges. Consult regularly with an experienced physician or nurse to determine the correct combination of proteins, carbohydrates, and fat intake for your particular situation. If you are obese, and diabetic conditions persist despite improved diet and medication regimens, consult with a physician about the possibility of bariatric, or gastric bypass surgery.

IMAGE ATTRIBUTES
Use of a Glucometer for Measuring Blood Glucose Levels is an Important Part of Diabetes Management. Posted at Wikimedia Commons.

 
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[Some rights reserved by George Parilla]
by Dr. Robert Aden

As a physician who is board certified in internal medicine and endocrinology, Dr. Robert Aden manages a busy medical practice in Miami. Following a fellowship in endocrinology, diabetes, and metabolism at New York University Medical Center, Dr. Aden obtained his endocrinology and metabolism board certification. Along with his private practice, Dr. Aden maintains affiliations with Baptist Hospital of Miami and South Miami Hospital.

Patients with type 2 diabetes who do not wish to be dependent on insulin or oral medications frequently opt for dietary management in order to control blood glucose levels. In many cases, insulin or oral medications remains necessary regardless of diet. In other cases, adopting a healthy diet, known as medical nutrition therapy for diabetes, may be sufficient to control blood sugar and reduce symptoms associated with type 2 diabetes. Medical nutrition therapy for diabetes also may foster weight reduction, which can further help control diabetes. The basics of the diet are as follows.

1. Eat healthy carbohydrates including fruits, vegetables, and whole grains. Limit sugars and starchy foods like potatoes and white bread.

2. Eat foods high in fiber, such as vegetables, legumes, and nuts.

3. Eat fish a few times a week. The omega-3 fats in fish can help lower triglycerides and inflammation associated with diabetes.

4. Opt for healthy monounsaturated and polyunsaturated fats from grain and vegetable sources.

5. Select foods with a low glycemic index, which have less of an impact on blood sugar levels.

6. Work with a doctor or dietician to reduce unhealthy carbohydrate intake and control the types of carbohydrates in the diet.

 
An Interview With Dr. Robert Aden: Autoimmune Thyroid Disorders

Dr. Robert Aden is board certified in internal medicine and endocrinology. In his Miami practice, he treats patients who have an array of endocrine disorders, such as type 2 diabetes and hypothyroidism. He is also a member of multiple professional societies, including The Endocrine Society, the American Association of Clinical Endocrinologists, and the American Diabetes Association. Recently, Dr. Aden answered questions about autoimmune thyroid disorders.

Question 1: What causes autoimmune thyroid disorders?

Dr. Aden: Autoimmune disease occurs when the body’s immune system begins to attack organs in the body. For some unknown reason,  the immune system cannot distinguish between native and foreign antigens. This reaction results in multiple forms of illness, including diabetes, Addison’s disease, and rheumatoid arthritis. In the case of autoimmune thyroid disorders, thyroid-reactive T-cells attack the thyroid gland. 

Question 2:  Are all thyroid diseases autoimmune?

Dr. Aden: No. Some forms of hypothyroidism are not autoimmune diseases. However,  Hashimoto’s thyroiditis and Graves’ disease are the two major forms of thyroid autoimmune disorders.

Question 3: Can you describe each of those diseases?

Dr. Aden: With Hashimoto’s thyroiditis, the body attacks the thyroid and the thyroid slowly loses it's ability to make thyroid hormone. When there's too little production of thyroid hormone, daily supplements of thyroid hormone must be taken. In Graves’ disease, the body makes antibodies that act like thyroid- stimulating hormone (TSH). This causes production of too much thyroid hormone, leading to an overactive thyroid.

Question 4: What is the treatment for each of these disorders?

Dr. Aden: We treat Hashimoto’s thyroiditis with synthetic or natural thyroid medications and careful monitoring of thyroid levels. Because the disease is incurable, patients probably will be on hormone replacement for the rest of their lives. Graves’ disease is treated most commonly with either radioactive iodine or antithyroid medication to halt excess hormone production. As a result, patients become hypothyroid and then must take hormone replacement medication for life.